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Benefit-cost in the California treatment outcome project: Does substance abuse treatment “pay for itself”?
Open accessAbstract
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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“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
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“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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“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
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Metadata
- 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.
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2005-10-20
- Volume
- 41
- Issue
- 1
- Pages
- 192-213
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- 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
- bronze
- doi.org
- 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
- Social Sciences › Sociology and Political Science › 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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