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Cited by 164Substance Abuse Treatment and OutcomesHealth Systems, Economic Evaluations, Quality of LifeHomelessness and Social Issues

Benefit-cost in the California treatment outcome project: Does substance abuse treatment “pay for itself”?

Open access
Ettner, Susan L., Huang, David, Evans, Elizabeth, Rose Ash, Danielle, Hardy, Mary, Jourabchi, Mickel, Hser, Yih‐Ing·2006·Health Services Research
DOI 10.1111/j.1475-6773.2005.00466.xPMC PMC1681530
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Abstract

Objective. To examine costs and monetary benefits associated with substance abuse treatment. Data Sources. Primary and administrative data on client outcomes and agency costs from 43 substance abuse treatment providers in 13 counties in California during 2000–2001. Study Design. Using a social planner perspective, the estimated direct cost of treatment was compared with the associated monetary benefits, including the client's costs of medical care, mental health services, criminal activity, earnings, and (from the government's perspective) transfer program payments. The cost of the client's substance abuse treatment episode was estimated by multiplying the number of days that the client spent in each treatment modality by the estimated average per diem cost of that modality. Monetary benefits associated with treatment were estimated using a pre–posttreatment admission study design, i.e., each client served as his or her own control. Data Collection. Treatment cost data were collected from providers using the Drug Abuse Treatment Cost Analysis Program instrument. For the main sample of 2,567 clients, information on medical hospitalizations, emergency room visits, earnings, and transfer payments was obtained from baseline and 9‐month follow‐up interviews, and linked to information on inpatient and outpatient mental health services use and criminal activity from administrative databases. Sensitivity analyses examined administrative data outcomes for a larger cohort (N=6,545) and longer time period (1 year). Principal Findings. On average, substance abuse treatment costs $1,583 and is associated with a monetary benefit to society of $11,487, representing a greater than 7:1 ratio of benefits to costs. These benefits were primarily because of reduced costs of crime and increased employment earnings. Conclusions. Even without considering the direct value to clients of improved health and quality of life, allocating taxpayer dollars to substance abuse treatment may be a wise investment.

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  • Among these domains, criminal activity typically contributes the largest share of the total economic consequences of substance use disorders and is the largest driver of social costs.

    “Of these domains, the relative contribution of criminal activity to the total economic consequences of SUDs is typically the largest driver of social costs.”

    From Monetary conversion factors for economic evaluations of substance use disorders (2017) · cites this paper as Ettner et al., 2006

    The ‘Pre-Post Changes in the Individual Sources of Monetary Benefit’ section (Table 2; page unavailable) reports a $5,676 reduction in crime costs over nine months, larger than the $3,352 increase in earnings. That supports crime as the largest contributor to the benefits measured in this California treatment cohort, but not the broader claim that crime is typically the largest driver of the total social costs of substance use disorders. (LLM, conf=0.84)

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  • The majority of cost-effectiveness analyses, cost-benefit analyses, and economic burden studies in this field estimate the economic consequences of substance use disorders from health care services, criminal activity, and labor market outcomes.

    “The majority of CEAs, CBAs, and economic burden studies in this field estimate the economic consequences of SUDs from health care services, criminal activity, and labor market outcomes (e.g., (Bouchery et al., 2011; Ettner et al., 2006; McCollister & French, 2003; Zarkin et al., 2015)).”

    From Monetary conversion factors for economic evaluations of substance use disorders (2017) · cites this paper as Ettner et al., 2006

  • Several forms of alcohol treatment are cost-effective and improve clinical outcomes.

    “various forms of alcohol treatment are cost-effective and improve clinical outcomes (8–15).”

    From Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials: SBI and referral to treatment (2015) · cites this paper as [10]

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1 of the 45 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [54]54. Vencill, C., and Z. Sadjadi. 2001. ''Allocation of the California War Costs: Direct Expenses, Externalities, Opportunity Costs, and Fiscal Losses.'' Justice Policy Journal 1 (1): 1-40.

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Authors
Ettner, S. L., Huang, D., Evans, E., Rose Ash, D., Hardy, M., Jourabchi, M., & Hser, Y.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Ettner, Susan L.
ORCID
Venue
Health Services Research
Publisher
Wiley
Published
2005-10-20
Volume
41
Issue
1
Pages
192-213
ISSN
  • 0017-9124 (ISSN-L)
  • 1475-6773
DOI
10.1111/j.1475-6773.2005.00466.x
PMC
PMC1681530
OpenAlex
W2156116126
Cited by
164
References
45
Citations by year
2026: 2 · 2025: 2 · 2024: 4 · 2023: 5 · 2022: 6 · 2021: 6 · 2020: 10 · 2019: 8 · 2018: 13 · 2017: 10 · 2016: 8 · 2015: 12 · 2014: 7 · 2013: 13 · 2012: 5
FWCI
5.76
Type
journal article
Language
en
Update notices
erratum (2006-03-09)
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Health Services Research (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Robert Wood Johnson Foundation
  • California Department of Alcohol and Drug Programs
  • AcademyHealth
  • National Institute on Drug Abuse
  • Center for Substance Abuse Treatment
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
Keywords
addiction treatment, cost-benefit analysis, treatment costs, monetary rewards, crime costs, employment income, mental health service utilization, health care costs, transfer payments
MeSH terms
California, Cost-Benefit Analysis, Humans, Surveys and Questionnaires, Cohort Studies, Substance Abuse Treatment Centers, Treatment Outcome, Episode of Care, Efficiency, Organizational, Substance-Related Disorders

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