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IN THE ABSTRACT

EFFECT OF PARITY LAWS

STUDY AND RESULTS Researchers from the University of Chicago's National Opinion Research Center and Lewin-VHI Inc. surveyed 1,850 people treated for drug abuse in a cost-benefit analysis of California's substance abuse treatment programs. The one-year study surveyed the randomly selected participants and re-interviewed them 15 to 24 months after the conclusion of the treatment. Researchers analyzed patients' reports of success or failure in remaining drug free and examined post-treatment criminal and health care records.

FINDINGS The study found that, for every $1 spent on drug and alcohol abuse, the public saves $7 in reduced crime. The state of California spent $209 million on treatment, which resulted in estimated savings of $1.5 billion. Expensive residential treatment programs resulted in cost benefits at a ratio of 1 to 4, while relatively inexpensive outpatient programs showed a cost-benefit ratio of 1 to 12.

FIND THIS STUDY Evaluating Recovery Services: The California Drug and Alcohol Treatment Assessment. Copies of this study can be obtained free of charge from California by calling (916) 327-3728.

STUDY AND RESULTS This report looks at the overall effectiveness of drug abuse treatment, the methodological issues affecting drug abuse treatment evaluations, and what is known about the effectiveness of specific treatments for heroin and cocaine and for adolescent drug addiction. It reviews and synthesizes findings from major evaluations of drug abuse treatment effectiveness.

WHAT'S IMPORTANT Considerable evidence from large, multi-site, longitudinal studies suggests that drug and alcohol abuse treatment is beneficial both to the individual undergoing treatment and to society. A substantial portion of clients report reductions in drug use and criminal activity. The study also finds that challenges in structuring research studies make it difficult to measure accurately the benefits of treatment. A number of major studies rely on self-reported data, so the benefits may be overstated. The study also finds that the best treatment approaches vary for specific groups of drug abusers.

FIND THIS STUDY Drug Abuse: Studies Show Treatment Is Effective, but Benefits May Be Overstated, by the U.S. General Accounting Office (GAO/HEHS-98-185, July, 1998).

STUDY AND RESULTS Researchers examined evidence that alcohol and other drug dependence are chronic medical illnesses. A literature review compared the diagnoses, genetic and environmental factors, pathophysiology, and response to treatments of drug dependence to both type two diabetes, hypertension and asthma. The degree to which the diseases are inherited, personal choice, and environmental factors are all involved similarly in the course of all four disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol and opiate dependence but not for stimulant or marijuana dependence. Adherence to medication and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness.

WHAT'S IMPORTANT This article suggests that long-term strategies of medication management and continued monitoring produce lasting benefits for alcohol and drug dependence as for other chronic illnesses. Drug dependence should be insured, treated and evaluated, as are other chronic illnesses.

CAVEAT This study is a literature review.

FIND THIS STUDY JAMA 284, No. 13 (Oct. 4, 2000) 1689-1695, http://www.jama.com

STUDY AND RESULTS This cross-site study collected extensive data about providers' treatment approaches and about their clients' characteristics and outcomes. Client outcomes were assessed by comparing information about client activities and experiences in the six months after discharge to similar information before treatment began. Cross-site data were collected from fall 1996 to summer 2001. The rate of premature delivery among clients in treatment was 7.3 percent, representing a 70 percent risk reduction, compared to an estimated 24 percent rate of premature deliveries among pregnant women in need of alcohol or drug treatment. Clients' rate of low birth-weight delivery was 5.7 percent, an 84 percent risk reduction, as compared to an expected 35 percent low birth-weight among untreated alcohol or drug abusers (also based on recent hospital-based studies). The infant mortality rate for clients' infants was 0.4 percent, a 67 percent risk reduction compared to the 1.2 percent infant mortality rate for previous client pregnancies. The percent of clients reporting use of specific substances during the six months following treatment was much lower than these same clients' reported use rates during the six months before treatment. Overall, 60 percent of the clients reported being completely alcohol- and drug-free throughout the six months following discharge. An additional 13 percent reported a relapse at some time since discharge, but were completely alcohol- and drug-free in the 30 days before the post-discharge interview.

WHAT'S IMPORTANT A cross-site evaluation of 50 CSAT-funded residential substance abuse treatment facilities for pregnant and parenting women found substantial health benefits to infants from reduced risks of low birth weight deliveries and other adverse pregnancy outcomes; high rates of post-treatment abstinence from alcohol and drugs; reduced criminal behavior; and improvements in economic well-being, personal relationships, and parenting status.

CAVEATS This study is a meta-analysis. The post-discharge period was only six months. The client outcome data have some large gaps and are based mainly on self-reported data of unknown accuracy. This paper reports pregnancy outcome findings only for pregnant clients who stayed in treatment through to delivery.

FIND THIS STUDY DHHS SAMHSA CSAT, September 2001. Call (301) 443-5052 to order a copy of the study.

STUDY AND RESULTS This study, which was published in the American Journal of Drug and Alcohol Abuse, looked at approximately 1500 subjects from 20 different residential substance abuse treatment programs to determine what effect residential treatment programs may have on relapse and recidivism rates. The study tries to account for selection bias seen in similar studies by accounting for factors such as background characteristics, type of treatment, post release services and amount of post-release supervision.

FINDINGS The results indicate that individuals who enter and complete residential treatment programs while in prison are less likely to experience new arrests and substance abuse during the first six months following release. The study found that 12.5 percent of the subjects had at lest one arrest for a new offense within six months and that inmates who completed treatment had longer times without an arrest than those who did not attend or complete treatment.

FIND THIS STUDY American Journal of Drug and Alcohol Abuse Vol. 2, Issue 27, 2001, pp. 315-337. It can be ordered from http://www.dekker.com/servlet/product/productid/ADA

STUDY AND RESULTS This report looks at current approaches to adolescent substance abuse treatment and summarizes research that assesses the effectiveness of intervention models designed specifically for adolescents. It also outlines ongoing programs attempting to address some of the methodological concerns of previous studies on adolescent treatment.

WHAT'S IMPORTANT The effectiveness of treatments for adolescents has only been studied for the last 10-15 years and more rigorous evaluations of effectiveness need to be performed to make more definitive conclusions. Using evidence from the effectiveness of adolescent substance abuse treatment programs will provide communities with opportunities to improve relapse and retention rates. The limited research suggests that programs need to be accessible, need to maximize treatment completion, include aftercare as a part of the continuum of care, provide comprehensive services that address educational, psychological, vocational, recreational, family, and legal concerns, include family therapy as part of treatment, and engender parent and peer support.

FIND THIS STUDY "An Overview of the Effectiveness of Adolescent Substance Abuse Treatment Models" was published in vol. 33, no. 2, of Youth & Society (pp. 143-168(26)). December 2001. It can be ordered from Ingenta at http://www.ingenta.com/.

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