Best Practices : Substance Abuse Treatment and Rehabilitation

6. Economic Benefits of Substance Abuse Treatment

There is fairly good evidence that people exposed to some types of treatment subsequently reduce their use of psychoactive substances and show improvement in other life areas. Beyond benefits to individuals and families, there are economic benefits for society as a whole, or at least for some sectors, and this has been demonstrated in some United States studies. It should be noted, however, that because the studies discussed below are based on the US health care financing system, the findings may not be easily generalizable to the very different Canadian health and social care system.

For alcoholism treatment, the best evidence for economic benefits within the health system comes from record-linkage studies involving health insurance claims from treated and untreated alcoholics. The largest study of this kind was reported by Holder and Blose (1992). This study focused on the costs of insurance claims to the health plan of a large manufacturing company in the mid-western United States by 3068 treated and 661 untreated alcoholics over the 14-year period 1974 to 1987. Alcoholics were identified from diagnoses on medical claim forms. Time series analysis showed that following treatment for alcoholism, the total cost of claims, including those for alcoholism treatment, declined by 23% to 55% from their highest pre-treatment levels. The cost of claims from untreated cases increased following identification. Analysis of variance controlling for pre-treatment health status and age also showed that post-treatment costs were reduced by 24%. The authors interpret these results as "providing considerable evidence that alcoholism treatment can reduce overall medical costs in a heterogeneous alcoholic population."

Other smaller-scale studies by Holder and colleagues (Holder and Blose, 1986; Holder and Hallan, 1986) and some earlier studies (reviewed by Holder, 1987) point to the same conclusions. Similar conclusions can be drawn from studies of pre- and post-treatment use of health services by clients of mental health services (Holder and Blose, 1987; Mumford et al., 1984).

Although these studies suggest that the positive effects of alcoholism treatment on the use of health care services apply to the entire populations in treatment, there is also evidence that these effects are greater for some groups than others. Holder and Blose (1986) found that age influenced pre-post-treatment differences in health care utilization among treated alcoholics. The youngest group (under 45 years) had the greatest drop in total costs following the onset of treatment and the post-treatment costs for this group declined to the lowest levels that existed prior to treatment. However, for those over 65, health care costs remained relatively stable after treatment and did not decline to pre-treatment levels. These results were replicated and extended by Blose and Holder (1991). However, Booth et al., 1990 found that in a sample of patients treated for alcoholism at a rural Veterans Administration Medical Center, alcohol-related hospital admissions were more frequent and for longer periods after alcoholism treatment than before. The authors speculate that the low socio-economic status of most cases in their study may account for the differences between their results and those of Holder and others.

Evidence for the economic benefits of treatment for problems with drugs other than alcohol comes from a large study of drug treatment in the United States (Hubbard et al., 1989). This study involved more than 10 000 drug users and 37 treatment programs that represented three main treatment modalities: methadone maintenance treatment, drug-free outpatient counselling and therapeutic community. Extensive intake, treatment and follow-up data were collected. The economic component of the study focused on the costs of drug-related crime. Two summary measures of these costs were developed: costs to law-abiding citizens, and costs to society. The cost to law-abiding citizens included those associated with crime-related property loss or damage, reduced productivity because of injury or inconvenience occasioned by drug-related crime, and the costs of criminal justice proceedings. Costs to society included cost to victims of drug-related crime, criminal justice costs and "crime/career/productivity costs" incurred when drug users are not involved in earning a legitimate income. The results showed that, in the population studied, both types of costs were lower after treatment than before and that pre-post differences in costs exceeded the costs of treatment. The pre-post differences in favour of law-abiding citizens were greatest for methadone maintenance treatment, while those for society as a whole were greatest for outpatient drug-free counselling.

Best Practice Guideline (No. 23)

There is good evidence that substance abuse treatment results in economic benefits for society as a whole, or at least for some sectors. Several studies indicate that the economic benefits resulting from some types of treatment exceed treatment costs.