Drug Abuse Costs - Term Paper Example

Running head: Drug Abuse Costs Drug Abuse Costs James Sedlar ENG 102 Barton October 25, 2009 Reducing Health Care Costs Relating to Alcoholand Drug Abuse Billions of dollars are spent annually on reducing drug abuse; analysts at the University of California, San Francisco estimate that the total cost of alcohol and drug abuse to be $166 billion annually (GAO, 1998, p. 2). In lieu of this situation and current attempts of both Canada and the United States to control health-care costs, a more analytical intensive policy from an existing and widely accepted therapy resulting in lower program costs and more successful program outcomes is crucial in delivering treatment which achieves the goal shared by all sectors involved in health care. The therapy subject to consideration in this proposal is Cognitive therapy which “attempts to identify and define maladaptive thoughts or beliefs” that contribute to addiction and/or relapse (Holder, et al., 1996, p. 520). Cognitive therapy is delivered in a variety of treatment modalities that range from inpatient and residential facilities to outpatient programs. Langenbucher (1996) identifies analytical tools that can be used to identify the value of treatment for drug and alcohol abuse that succinctly addresses program costs. Some elements included in his framework are cost-of-illness, cost-offset and cost-benefit analyses which focus on the cost of the disease if it is left untreated. This type of analysis endeavors to identify the costs, both covert and explicit, that accompanies addiction in terms of decreased productivity and unemployment, future healthcare costs, and increased demands on the criminal justice and social services systems. Alternately, cost-effectiveness analyses “compare two or more treatments by determining the cost of a given desirable outcome using each treatment” (Langenbucher, 1996, p. 2). A disclaimer however on this framework: Langenbucher’s analysis also compares the cost of treatment to the benefits that accrue, that is, the success that can be measured after the treatment. While there is a general consensus that successful treatment is economically viable when compared to the costs of continued addiction, there is little consensus as to which types of treatment are most efficacious. Thus cost-effectiveness should also take into consideration success rates of alternate types of treatment and this will be expounded on further later. The costs of cognitive therapy programs vary considerably. According to Holder, et. al. in-patient treatment costs as much as $300 per day while the out-patient treatment may cost as little as $34 per day. Thus, inpatient or residential treatment may cost as much as ten times that of outpatient treatment. At present there is a body of data that outlines the costs of various treatment options. The cost of a specific treatment program can be determined by noting its cost or price (how much it bills public or private insurers or the individual in question). This applies to both inpatient and outpatient programs. If this figure is then divided by the duration of the program (in the case of inpatient treatment) or the number of visits or events constituting the program (in the case of outpatient programs) one has a set of economic data that is conducive to meaningful contrast and comparison. This is the method employed most frequently in the existing research. (Chapman and Hutgens, 1988; O’Neill, 1991) Meaningful analysis of program outcomes, on the other hand, demands that the characteristics of the subjects be determined at their entry into treatment; after all it is through proper assessment that an institution knows if its policies are successful or not. The Form 90 questionnaire is frequently employed to reconstruct alcohol consumption. Form 90 assesses alcohol consumption on the basis of a timeline follow-back method (TLFB) that chronicles daily usage over a 90 day period and a grid averaging method that identifies patterns of usage (i.e. ‘binge’ drinking as opposed to daily consumption). Additionally, Form 90 quantifies several related domains such as institutionalization, residential status and health care utilization. According to Tonigan et. al. when Form 90 is administered by “intensively trained interviewers, who follow manual-guided procedures” it “provides reliable estimates of alcohol consumption and related variables and represents one of several structured assessment procedures to quantify drinking behavior” (1997, p. 364). In addition to Form 90 a variety of other assessment tools of proven accuracy are available to assess the constellation of issues that surround simple consumption patterns. Timko et. al. (1999) indicate that the Health and Daily Living (HDL) Form, the Rosenberg Self-Esteem Scale and the Life Stressors and Social Resources Inventory all provide sound and valid analysis of issues such as self-esteem, depression and stress that provide valuable baseline data. Therefore, both alcohol usage and related issues can be adequately measured as a baseline and throughout the study. With that said, this literature clearly establishes the costs of cognitive therapy treatment programs and it also identifies a variety of tools that can be employed to determine the characteristics of subjects identified as alcohol dependent which can also be used to assess treatment outcomes. In a remarkably soft report the Government Accounting Office concluded that treatment probably had some beneficial effect: “Drug abuse treatment is beneficial, but reliance on self-reported data may overstate treatment effectiveness….objective tests, such as urinalysis, consistently identify more drug users than self-reports do”(GAO, 1998). This then leads us to the conclusion that the specificity and accuracy of the data from simple questionnaires is sorely lacking. Additionally, little data relating outcome rates to treatment costs is available and even less of this data is then employed to compare different treatment programs or modalities. In other words, research into treatment outcomes is deficient and research into the cost-effectiveness of treatment alternatives is virtually non existent. Analysis of the relative cost-effectiveness of two treatment modalities requires the generation of two related sets of statistics, focusing on two independent variables. Initially, the cost of treatment must be determined. Subsequently the success rate of the treatment modality in question must be determined and finally, this data must be correlated and compared. For example, let us assume that inpatient treatment is five times as expensive as outpatient treatment. Only if the former is five times as effective as the latter is it cost-effective. If outpatient treatment can be delivered at one-fifth of the cost of inpatient treatment with a success rate that is half that of inpatient programs then the cost-effective approach is the outpatient treatment. While it is less effective in absolute terms it significantly lowers costs rendering it more cost-effective. It is also more appropriate to consider the cost of the total treatment program rather than the cost per day or per event. For example, per day or per event comparison is only valid if the two programs involve an equal number of days and events. It would be more accurate to view the cost of the total treatment regimen rather than an event/day comparison and thus a comparison of a 28-day inpatient program with a 52-event (i.e. weekly for one year) outpatient program would be more meaningful if the total cost of the program, rather than when the per day and per event costs were compared. However, definition and determination of the effectiveness of treatment is a more elusive goal. In the first place, the level of addiction of the individuals comprising the two sample groups must be comparable. If individuals who participate in outpatient programs are less alcohol dependent than those in inpatient programs then there is little basis for comparison. Therefore, any comparative analysis must commence by assessing the usage patterns and relative dependence of the two samples, hence the deference again lies in the methodology of collecting data of the treatments’ outcomes. Form 90 was identified earlier but there are constellations of commonly employed and widely accepted tests that take into account a variety of related mood and personality issues. It is important therefore to include a measure of alcohol usage over time and a measure of functioning and mood to determine the comparability of those involved in inpatient and outpatient cognitive therapy. Application of these measures would permit the study groups to be divided into comparable levels of dependency. Thus, the group could be divided into highly dependent, dependent and limited dependent groups whose treatment outcomes could then be more meaningfully compared. Participants should also receive this battery of tests prior to, upon completion of, and subsequent to treatment. This study group would be initially tested to determine baseline levels and categorize participants. The tests would be delivered again 3 months after the commencement of treatment, one year after the baseline testing, and two years after that. Since ‘relapse’ and a return to dependency is a frequent occurrence with alcoholics, two years is considered a minimum period for follow-up. The question of follow up, specifically the duration of testing is an ongoing debate. Ideally, testing would be conducted as frequently and for a long a period of time as possible but this would lead us back again to the question of program costs. Funding restrictions and other considerations prohibit the infinite testing of participants despite its desirability. Ultimately, cost-effectiveness amounts to, in crude terms, the cost per successful outcome. This data reveals a wide range of interesting outcomes at this point. For example, unless the success rate of residential treatment is at least 30% it cannot possibly be as cost-effective as outpatient treatment. Alternately, even if outpatient treatment only demonstrates a success rate of 8% it is more cost-effective than in-patient treatment unless in-patient treatment maintains a success rate exceeding 40%. Finally, what is vital to every policy is that the cost per person must be collated with the success rate. Essentially this step demands statistical rigor rather than psychological experience and this final calculation is the key to this entire proposal. This paper then gives valuable insight: First, programs with significantly different rates of successful outcomes may be closely linked and compared in terms of cost-effectiveness. Following from that, it reinforces the point that cost-effectiveness rather than simply outcome rates is the most important measure of a program’s value. Cost-effectiveness analysis then becomes a central analytical tool in social services which can be employed in a variety of social services programs. References Chapman, PLH, and Hutgens, I. 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