Substance Abuse Treatment Reduces Costs to Society; Eliminating Substance Abuse Treatment Increases Costs
Michael Dennis, Ph.D.* Christy K Scott, Ph.D.**and Mark D. Godley, Ph.D.*Chestnut Health Systems, *Normal & **Chicago, IL
February 22, 2011
Presentation to the Illinois Alcoholism and Drug Dependency Association www.iadda.org . This presentation uses data collected from Haymarket Center in Chicago as part of National Institute on Drug Abuse (NIDA) Grant no R37 DA011323, Chestnut Health Systems under National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant no. AA 10368 , and data from 148 grant evaluations pooled for secondary analysis under Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT) contract no. 270-07-0191.The opinions are those of the author and do not reflect official positions of the government. Comments or questions about this report can be addressed to Michael Dennis, Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, phone 309-451-7801, fax 309-451-7765, e-Mail: [email protected]
Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004 in 2009 dollars
The Cost of Substance Abuse Treatment is Trivial Relative to the Costs Treatment Reduces
$407$1,132$1,249$1,384$1,517$2,486$4,277
$10,228$14,818
$0 $10,
000
$20,
000
$30,
000
$40,
000
$50,
000
$60,
000
$70,
000
Screening & Brief Inter.(1-2 days)Outpatient (18 weeks)
In-prison Therap. Com. (28 weeks) Intensive Outpatient (12 weeks)
Adolescent Outpatient (12 weeks)Treatment Drug Court (46 weeks)
Methadone Maintenance (87 weeks)Residential (13 weeks)
Therapeutic Community (33 weeks)
$22,000 / year to incarcerate
an adult
$30,000/ child-year in foster care
$70,000/year to keep a child in
detention
• $750 per night in Medical Detox• $1,115 per night in hospital • $13,000 per week in intensive care for premature baby• $27,000 per robbery• $67,000 per assault
SBIRT models popular due to ease of implementation
and low cost
Investing in Treatment results in a Positive Return on Investment (ROI)
Substance abuse treatment has an ROI of between $1.28 to $7.26 per dollar invested.
Consequently, for every treatment dollar cut in the proposed budget, the actual costs to tax payers will increase between $1.28 and $7.26.
Bottom line = The proposed $55,000,000 cut will cost Illinois taxpayers between $70,400,000 and 399,300,000 within the next 1 to 2 years.
Source: Bhati et al., (2008); Ettner et al., (2006)
Unit Costs Used in 2009 DollarsDescription Unit Cost in 2009 dollars
Inpatient hospital day Days $ 1,409.69
Emergency room visit Visits $ 265.52
Outpatient clinic/doctor’s office visit Visits $ 75.59
Nights spent in hospital Nights $ 1,409.69
Times gone to emergency room Times $ 265.52
Times seen MD in office or clinic Times $ 75.59
Days bothered by any health problems Days $ 25.22
Days bothered by psychological problems Days $ 9.74
How many days in detox Days $ 254.82
Nights in residential for AOD use Nights $ 149.21
Days in Intensive outpatient program for AOD use Days $ 102.51
Times did you go to regular outpatient program Times $ 276.17
Days missed school or training for any reason Days $ 18.08
How many times arrested Times $ 2,091.51
Days on probation Days $ 5.67
Days on parole Days $ 18.29
Days in jail/prison/detention Days $ 79.75
Days detention/jail Days $ 111.77
*Quarterly cost to society 2009 dollars
Haymarket Clients
As part of NIDA grant R37 DA011323, a cohort of 436 adults sequentially admitted to Haymarket Center in Chicago were interviewed at intake between February to March, 2004 and quarterly for 4 years (with over 95% completion)
In 2009 dollars, clients averaged $3698 in costs to society in the 90 days before accessing treatment ($15,383 in the year before intake)
Before entering outpatient treatment, clients incurred lower quarterly costs when compared to clients entering long term residential ($2,191 vs. $4,749).
During the year prior to treatment, this cohort of 436 adults cost society $6,707,103. Without treatment, these costs would have continued.
Change in Quarterly Costs To Society: Haymarket Center Cohort
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
Intake 12 24 36 48
Months from Intake
Qu
arte
rly
Cos
ts t
o S
ocie
ty
Treatment costs initially increase costs
Followed by a sustained period of reduced quarterly costs
Source: Dennis & Scott NIDA Grant no. R37 DA011323
Cumulative Actual Costs Minus ExpectedCosts To Society
($14,589)($20,000)
($15,000)
($10,000)
($5,000)
$0
$5,000
$10,000
Intake 12 24 36 48
Months from Intake
Cu
mu
lati
ve N
et C
ost
to S
ocie
ty
Additional Cost of Treatment offset by Savings
in other costs within 18 months
Over 4 years, cumulative saving of $14,589 per person($6,360,804 for 436 person
admission cohort)
Source: Dennis & Scott NIDA Grant no. R37 DA011323
Cumulative Actual Minus Expected Costs To Society: Haymarket by Level of Care
OP , ($8,552)
IOP , ($18,433)
STR , -4,542.00
LTR , -$21,698
-25,000
-20,000
-15,000
-10,000
-5,000
0
5,000
10,000
Intake 12 24 36 48
Months from Intake
Cu
mu
lati
ve N
et C
ost
to S
ocie
ty
All Levels of Care Produced
Net Savings
Though the most expensive initially, long term treatment also produced
the most long term savings
Similarly, IOP produced greater savings that OP
Source: Dennis & Scott NIDA Grant no. R37 DA011323
Chestnut Health Systems’ Adolescent Residential Clients
As part of NIAAA grant R01 AA 10368 , a cohort of 355 adolescents were recruited at discharge between 2004 and 2008 from Chestnut’s residential treatment programs in central and southern Illinois and interviewed quarterly for 1 year (with over 90% completion)
In 2009 dollars, they averaged $6,554 in costs to society in the 90 days before intake ($26,217 in the year before intake)
This 4 year cohort of 355 adolescents cost society $9,307,163 in the year before they were admitted to Chestnut – costs they would have continued to incur if they were not treated
Change in Quarterly Costs To Society: Haymarket Center Cohort
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
3 6 9 12
Months from Intake
Qua
rter
ly C
osts
to
Soci
ety
* Cost of residential treatment
Outpatient Continuing Care plus other Costs Consistently Below Baseline Costs
Source: Godley NIAAA Grant no. R01 AA 10368
More Intensive Continuing Care Produced Greater Savings*
$4,816
$7,876
$10,910
$11,559
$0 $2,0
00
$4,0
00
$6,0
00
$8,0
00
$10,
000
$12,
000
$14,
000
Usual Continuing Care (UCC)
UCC + Contingency Management(CM)
UCC + Assertive Continuing Care(ACC)
UCC + CM + ACC
* Cost of residential treatment
Usual Continuing Care (UCC)
UCC+ Contingency Management (CM)
UCC+Assertive Continuing Care (ACC)
UCC + CM + ACC
Source: Godley NIAAA Grant no. R01 AA 10368
* Defined as 12 month post discharge costs to society minus 12 month pre intake costs to society
SAMHSA/CSAT’s Clients by Level of Care
As part of SAMHSA/CSAT contract 270-07-0191, data has been pooled from 22,045 clients from 148 local evaluations, recruited between 1997 to 2009 and followed quarterly for 6 to 12 months (over 80% completion)
In 2009 dollars, the 2,793 adults averaged $1,417 in costs to society in the 90 days before intake ($5,669 in the year before intake)
In 2009 dollars, the 16,915 adolescents averaged $3908 in costs to society in the 90 days before intake ($15,633 in the year before intake)
SAMHSA/CSAT’s Adolescents Clients by Level of Care
Adolescent Level of Care
Year before intake
Year after
Intakea
One Year
Savingsb
Outpatient $10,993 $10,433 $560
Intensive Outpatient $20,745 $15,064 $5,682
Outpatient Continuing Care $34,323 $17,000 $17,323
Long Term Residential $27,489 $26,656 $833
Short Term Residential $25,255 $21,900 $3,355
Total $15,633 $13,642 $1,992
\a Includes the cost of treatment\b Year after intake (including treatment) minus year before treatment
SAMHSA/CSAT’s Adult Clients by Level of Care
Adult Level of Care
Year before intake
Year after
Intakea
One Year
Savingsb
Outpatient $12,806 $9,241 $3,565
Intensive Outpatient $15,263 $15,197 $ 66
Outpatient Continuing Care $34,057 $14,310 $19,748
Residential $19,443 $24,297 ($4,854)c
Total $17,035 $12,442 $4,592
\a Includes the cost of treatment\b Year after intake (including treatment) minus year before treatment\c Cost of residential treatment is not offset yet at one year after intake
These Analyses Provide Converging Evidence That
Substance Abuse Treatment Programs serve individuals who are costing society a great deal. Eliminating treatment will NOT eliminate costs associated with substance abuse….We will pay.
The proposed $55,000,000 cut will cost Illinois taxpayers between $70,400,000 and 399,300,000 within the next 1 to 2 years.
The cost of treatment is offset by total savings to society within 6 months to 3 years post-intake and produce cumulative benefits that continue to grow for many years.
While providing more intensive treatment and continuing care costs more in the short run, it also produces the greatest benefit in the long run to tax payers.
Conversely This Suggests That..
Cutting substance abuse treatment will likely increase total costs to Illinois taxpayers via increased costs associated with healthcare, welfare and incarceration
Focusing on the least expensive and/or intensive treatment options to reduce short term costs will significantly reduce the long term benefits.
References
Bhati et al. (2008) To Treat or Not To Treat: Evidence on the Prospects of Expanding Treatment to Drug-Involved Offenders. Washington, DC: Urban Institute.
Capriccioso, R. (2004). Foster care: No cure for mental illness. Connect for Kids. Accessed on 6/3/09 from http://www.connectforkids.org/node/571
Chandler, R.K., Fletcher, B.W., Volkow, N.D. (2009). Treating drug abuse and addiction in the criminal justice system: Improving public health and safety. Journal American Medical Association, 301(2), 183-190
Ettner, S.L., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi, M., & Hser, Y.I. (2006). Benefit Cost in the California Treatment Outcome Project: Does Substance Abuse Treatment Pay for Itself?. Health Services Research, 41(1), 192-213.
French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates of cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462-469
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