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The Outcomes of Addiction Treatment and Approaches to Measuring Performance
Year Two of SAMHSA Funded Project Sponsors Visits to State Legislatures

• Whether patient relapse really means treatment “failed” when it can be shown to have saved public dollars through decreased costs for incarceration, emergency room use or less need for expensive child welfare services.
• Ways to know if treatment is producing savings in excess of the investment, and if the savings appear in other agency budgets such as criminal justice, public health, public safety, or child welfare. 
• Innovative experiments in other states to increase return on investment through purchasing, administrative and regulatory reform. 
• Ways to relieve provider burden by eliminating duplicative and time-consuming data collection requirements.

During 2006, six requesting states received project-sponsored visits to help them address performance and measurement topics of their choosing.  A seventh workshop was conducted for emerging legislative leaders participating in the NCSL “Critical Health Areas Project” meeting in San Antonio, Texas.

On March 2, 2006 TRI’s Mady Chalk, Ph.D., former SAMHSA official, presented The Burden of Public Responsibility to members of the Massachusetts State Legislature, a discussion of performance improvement in the context of declining private sector support for substance abuse treatment.

On March 8, in Colorado and April 25 in Albany, New York, TRI Executive Director A. Thomas McLellan, Ph.D. delivered Reconsidering Addiction Treatment: How Can Treatment be More Accountable and Effective? The presentations discussed new ways to look at treatment effectiveness and legislators’ options for promoting accountability through performance improvement initiatives.  At the Albany briefing, Dr. McLellan was joined by Ken Stark from Washington State who delivered Expanding Alcohol/Drug Treatment: An Investment in Health Care Cost Containment and Public Safety, a demonstration of how cost savings across state agencies are realized from substance abuse treatment dollars.

On March 22, Dr. Chalk presented Good Data, Good Reports … What Now to Oklahoma legislators discussing ways to put outcome and performance data to work in quality improvement and accountability projects.

On April 21, Bonnie Catone, TRI’s Director of Communications, presented on behalf of Dr. McLellan to a gathering of legislators, agency staff and providers in Concord New Hampshire.

The final presentation to an individual State Legislature occurred in Casper, Wyoming on May 15 before the Select Committee on Mental Health and Substance Abuse.  TRI’s Mady Chalk, Ph.D. presented Reconsidering Addiction Treatment, a discussion of outcome and performance measures and their use in quality improvement and accountability.  Also presenting was Antoinette Krupski, Ph.D., Administrator of Evaluation and Quality Assurance in the Washington State Division of Alcohol and Substance Abuse.  In her presentation, Expanding Alcohol/Drug Treatment: An Investment in Health Care Cost Containment and Public Safety, Dr. Krupski demonstrated savings to other Washington State agencies and reductions in arrests following AOD treatment and, importantly, included valuable and policy relevant information on the use of data sharing agreements among agencies.

The December 5, 2006 workshop in San Antonio Texas was the final briefing of the year, sponsored by NCSL’s Critical Health Areas Project (CHAP) and, featuring TRI’s A. Thomas McLellan, Ph.D., Ken Stark from Washington State and a reactor presentation from Rebecca Crowell, Executive Director of Nexus Recovery, a treatment agency in Dallas, Texas.  CHAP is an ongoing educational project on health care issues targeting emerging State legislative leaders from around the country.  Presentations from the CHAP workshop were video recorded and will be posted on this site for web based viewing.  

Helpful Resources

“The Burden of Public Responsibility,” a presentation by Mady Chalk, Ph.D. before the Massachusetts State Legislature, March 2006.

“Reconsidering Addiction Treatment: How Can Treatment be More Accountable and Effective?” A presentation by A. Thomas McLellan, Ph.D. before the Colorado State Legislature, March 2006

SSI Cost-Offset Study from Washington State, available at: http://www1.dshs.wa.gov/pdf/ms/rda/research/11/125.pdf

Report from the National Quality Forum: “Evidence-Based Treatment Practices for Substance Use Disorders”

National Expenditures Report from SAMHSA

Fact Sheet on SAMHSA’s National Outcomes Monitoring System: “NOMS”

“The Economic Benefits of Substance Abuse Treatment,” a report by TRI’s Steven Belenko, Ph.D.

“Drug Dependence, A Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation” by A. Thomas McLellan, Ph.D.

“Rewarding Results: Improving the Quality of Treatment for People with Alcohol and Drug Problems.” Recommendations from a national policy panel convened by Join Together.

Report on the Costs and Effectiveness of Alcohol and Drug Abuse Programs in Colorado.

Reconsidering Addiction Treatment, a presentation by Mady Chalk, Ph.D., before the Select Committee on Mental Health and Substance Abuse, Casper Wyoming, May 15, 2006.

Expanding Alcohol/Drug Treatment: An Investment in Health Care Cost Containment and Public Safety, by Antoinette Krupski, Ph.D., before the Select Committee on Mental Health and Substance Abuse, Casper Wyoming, May 15, 2006.