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: mdennis@Chestnut.Org

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