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Study Shows Drug Abuse Programs Are Cost-Effective

August 29, 1994|SHERYL STOLBERG | TIMES MEDICAL WRITER

For every dollar spent on treatment for drug and alcohol abuse, California taxpayers reap $7 in savings, mostly due to reductions in crime and health care costs, a new statewide survey has found.

The cost-benefit analysis, billed as the most comprehensive ever conducted in the United States, also confirmed what smaller studies have shown: Treatment is highly effective, regardless of the type of program or the drug, and success cuts across all racial and socioeconomic lines.

The study, financed by the state but conducted by an independent research institute, comes at a time of great public skepticism over the benefits of such social programs. There was intense debate over whether President Clinton's health care reform should cover treatment; ultimately, it was included.

"It's very important that there be a continuously developing database to demonstrate to the American public the cost effectiveness of drug abuse treatment," said Alan Leshner, director of the National Institute on Drug Abuse, an arm of the National Institutes of Health. "Most people don't believe treatment works, and they're wrong. That's why a study like this is so important."

The study, which will be released today by the California Department of Alcohol and Drug Programs, estimated that $1.5 billion in savings resulted from the $209 million the state spent on treatment between October, 1991 and September, 1992.

Declared Andrew Mecca, director of the department: "This is what I call slam-dunk evidence."

In the year before treatment, the study found, those who later would be enrolled in drug abuse programs cost state taxpayers $3.1 billion. Of that, $2.4 billion--or 70%--was attributed to crime, including the cost of police protection, prosecution and incarceration. Victims of crimes committed by drug abusers, meanwhile, incurred $1.3 billion in medical costs, damaged or stolen property and lost work. Health care for drug abusers totaled $442 million.

Fifteen months after treatment, the cost of crimes tied to the group in treatment had dropped by $1 billion, the study said, accounting for the biggest chunk of savings. The study also found a considerable drop in health care expenditures; emergency room admissions, for instance, decreased by one-third after treatment.

The study based these conclusions on subjects' recollections of their behavior--including crimes they committed--before and after they had undergone treatment. But the authors say they took pains to avoid exaggerating savings, noting that previous research had shown such self-reporting to be "as valid as drug testing."

One sobering finding in the study was that treatment was of little help in getting drug abusers on more stable economic footing. Treatment did not lead to employment, although the research did find that the longer participants stayed in treatment, the more likely they were to find a job afterward.

Mecca, Leshner and other experts say they hope to use the $2-million study to persuade skeptical elected officials that they should continue to invest public money in drug abuse treatment. In this regard, the research may prove more a benefit to states other than California, which has already increased annual spending on treatment by nearly $120 million since the study was conducted.

The study found that use of crack cocaine, cocaine powder and amphetamines declined by almost half after treatment, while heroin use declined by more than one-fifth and alcohol use by nearly one-third. The findings about crack abuse surprised the study's authors, who said they did not expect to learn that it could be treated so effectively.

"No one has really determined that previously," said Dean R. Gerstein of the University of Chicago's National Opinion Research Center, which conducted the study.

While the essential conclusion of the report--that treatment works and saves money--came as no surprise to those in the field, experts say the study is especially important because it was so rigorously conducted.

"This is the first time that I've seen the return on the investment so clearly laid out," said M. Douglas Anglin, director of the UCLA Drug Abuse Research Center, which was not involved in conducting the study. "Now, we can really be confident when we pound on our lecterns and say treatment works."

While previous research has looked at only a handful of treatment centers--often focusing on those considered model programs--the California study employed random sampling methods to draw a complete picture of 146,515 people enrolled in an array of programs throughout the state's 58 counties.

And while other studies have tracked people for 60 or 90 days after treatment, the California study interviewed 1,857 subjects 15 months after treatment had concluded. The participants will continue to be followed, Mecca said.

According to Leshner of the National Institute on Drug Abuse, smaller studies have shown a benefit of anywhere from $4 to $20 for every dollar invested. Thus, the California study's finding of $7 in savings for every dollar spent puts it on the conservative end of the research spectrum.

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