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APHA Scientific Session and Event Listing

Recorded presentation

Harold A. Pollack, PhD, School of Social Service Administration, University of Chicago, 969 East 60th St, Chicago, IL 60637, 7737024414, haroldp@uchicago.edu, A. David Paltiel, PhD, Department of Epidemiology, Yale University School of Medicine, 60 College Street, Room 305, New Haven, CT 06520-8034, and Anirban Basu, PhD, Section of Internal Medicine, University of Chicago Department of Medicine, 5841 S. Maryland Ave, MC-2007, Chicago, IL 60637.

Background: Reduced crime provides a key benefit associated with substance abuse treatment (SAT). Armed robbery is one of the most costly of these offenses, given the frequency and severity of this crime among a minority of substance-users. Many studies employ direct-cost valuation methodologies which likely understate the true costs of armed robbery, and thus the benefits of SAT-associated robbery reductions. At the same time, regression to the mean and self-report bias may lead pre-post comparisons to overstate SAT-related crime reductions. Data and methodology: Using 1992-97 data from the National Treatment Improvement Evaluation Study, we examine pre-post differences in self-reported robbery among clients in 5 residential and outpatient SAT modalities. Fixed-effect negative binomial regression is used to examine incidence rate reductions in armed robbery. Willingness-to-pay methods are used for social valuations of these effects. Differences in incidence rate reduction across SAT modalities was used to bound potential biases. As a worst-case, we assume that our least-intensive modality has no true causal effect. Results: All modalities were associated with large and statistically significant reductions in robbery. The average number of self-reported robberies declined from 0.83/client/year pre-entry to 0.12/client/year following SAT (p<0.001). Even under worst-case assumptions, reductions in armed robbery offending associated with outpatient methadone and residential SAT exceed economic costs of these interventions. Conclusion: Conventional wisdom posits the economic benefits of SAT. We find that treatment creates even larger social benefits than is commonly assumed. Social valuation of reduced armed robbery alone appear to outweigh the economic costs of SAT interventions.

Learning Objectives: At the conclusion of the session, participants will be able to

• Elucidate accepted findings on the net benefits of substance abuse treatment.
• Articulate different valuation methodologies to estimate the social costs of crime.
• Identify pre- and post-treatment patterns of criminal offending in a prominent national sample of treatment clients.
• Identify the net social benefits of substance abuse treatment in a national sample.

Keywords: Cost-Effectiveness, Substance Abuse Treatment

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation