The finding of at least a 7-to-1 return on public investment in substance abuse treatment could fuel support for such programs among the public and policymakers in an increasingly tight financial environment.

Substance abuse treatment advocates in California have a new tool to gather support for increased funding, with the release of a recent study that found every dollar spent on substance abuse treatment generates more than $7 in monetary benefits for society.

The study, published in the November Health Services Research, found that the average substance abuse treatment cost in California is $1,583 per patient and is associated with a societal benefit of $11,487 in return, which is more than a 7-to-1 ratio of benefit to costs. The ratio rose to 9-to-1 when the researchers inflated arrest data to approximate actual crimes committed. The ratio is based on weighted average treatment costs and benefit measures that demonstrated significant change. Weighted average is each program's cost divided by client days.

All of society is already paying huge costs imposed by hard-core substance abusers, said Susan Ettner, Ph.D., lead author and a professor of general internal medicine and health services research at the David Geffen School of Medicine and School of Public Health at the University of California at Los Angeles.

Ettner said investments in substance abuse treatment make good business sense, without even considering the associated prevention of human suffering and victimization.

The societal benefit was divided between various factors, including 65 percent attributed to cuts in crime, 29 percent to increased income, and six percent due to reduced medical and behavioral health care costs.

The treatment costs were estimated based on the length and average daily cost of each type of substance abuse treatment.

The study was based on data from the California Treatment Outcome Project (CalTOP), which collected outcome data on persons admitted to 43 substance abuse treatment providers in 13 California counties, including three methadone maintenance programs, 19 drug-free outpatient programs, and nine residential programs. The study had a response rate of 72 percent. The patient findings were based on 2,567 patients entering substance abuse treatment between January 2000 and May 2001 who also completed a nine-month follow-up survey.

Cost reductions occurred in hospital inpatient use, emergency room visits, and mental health services. "Victimization costs" dropped by $3,019, and other costs associated with criminal activities were reduced by $2,657. Incarceration costs dropped by $1,788, and personal earnings increased by $3,352. The monetary benefit findings were based on the survey and administrative data, which included medical care, mental health services, criminal activity, earnings, and government payments. The monetary benefits were based on a comparison of the costs each patient incurred before treatment with costs after treatment, so each client served as their own "control."

The California Department of Drug and Alcohol Programs, the Center for Substance Abuses Treatment, and the Robert Wood Johnson Foundation provided funding for the study.