The 130th Annual Meeting of APHA

4010.0: Tuesday, November 12, 2002 - 9:06 AM

Abstract #44114

Cost-effectiveness of self-help aftercare in drug abuse treatment: An instrumental variables approach

Donald S. Shepard, PhD1, James McKay, PhD2, Hyong S Yeom, MSW3, Gail Strickler, MA3, Craig Love, PhD4, Denise P Bury-Maynard, PhD5, Jeanne Calabro, MA3, and Jill Tetreault1. (1) Schneider Institute for Health Policy, Heller School, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454-9110, 781-736-3975,, (2) Treatment Research Center, University of Pennsylvania, 234 38th Street, Philadelphia, PA 19108, (3) Schneider Institute for Health Policy, Heller School, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, (4) Center for Race and Ethnicity, Brown University, Box 1886, Providence, RI 02912, (5) Center for Alcohol and Addiction Studies, Brown University, Box G-BH, Providence, RI 02912

Persons with drug and alcohol abuse, like those with other chronic and relapsing conditions, generally benefit from continuing care (aftercare) following intensive treatment. Participants in Alcoholics Anonymous, Narcotics Anonymous, and other "self-help" or mutual help programs often relapse less frequently. In this paper, we report on the effectiveness and cost-effectiveness of different aftercare services, as measured by subsequent substance use, crime, employment, etc. The study randomized 408 subjects between relapse prevention aftercare and usual aftercare after their initial treatment. All clients were free to access mutual-help aftercare at any time and were interviewed every 6 months for 2 years. We quantified the type and intensity of mutual help participation during the preceding 6-month intervals with questions from the Alcoholics Anonymous Questionnaire. Our cost measurements included counselor time, client time and travel, and other expenses. We used multivariate statistical methods with lagged and instrumental variables analysis to estimate the impact of mutual help on outcomes, controlling for selection bias between users and nonusers of mutual help. Preliminary results indicate that mutual-help aftercare was associated with significant improvements in substance use and employment, but not crime. Clients who attended at least one mutual-help session in a 6-month interval had a 40.0% rate of substance use in the next interval, compared to 50.5% rate among those who did not. Based on 866 linked-interval observations, we found that for each additional mutual-help session attended per week, the risk of subsequent substance use declined by 16% (p<0.001). Because of the accessibility and power of mutual-help aftercare, it appears to be a particularly cost-effective approach.

Learning Objectives:

Keywords: Treatment Outcomes,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Effectiveness and Cost-Effectiveness of Treatment and Aftercare

The 130th Annual Meeting of APHA