Researchers in U.S. surveyed 1,799 patients to compare the cost-effectiveness of four types of substance abuse treatment programs: inpatient, residential, outpatient detox/methadone, and outpatient drug‐free.
There were only minor differences with regard to effectiveness of these programs. However, they varied considerably with regard to cost‐effectiveness. Outpatient drug‐free programs are the most cost‐effective.
The treatment programs these patients attended fall into one of the four types:
- Inpatient programs generally adopt a medical model of substance disorders. They provide intensive medication and counseling in a relatively short period of time. Many inpatient programs are part of psychiatric or general hospitals.
- Residential programs are mostly modeled after the therapeutic communities of the 1950s, which aimed to change the lifestyle of the drug abuser through a long‐term communal experience. The main distinguishing characteristics of these programs are the use of peer‐counselors and less reliance on medical and non-medical professional staff.
- Outpatient detox and methadone programs have a common feature of reliance on pharmacological agents including methadone and other psychotropic agents. Thus, the proportion of clients receiving medications is generally higher than residential or outpatient drug‐free programs.
- Outpatient drug‐free programs emphasize counseling rather than medication as a major component of treatment. Clients continue to live in the community and go to clinics on a regular basis for counseling sessions.
In their study, researchers assessed substance abuse outcome using a comprehensive interview with the 1,799 patients five years after discharge. Treatment success was defined in two ways: as abstinence and as any reduction in substance use.
14 substances or categories of substances were included in the study: alcohol, crack, cocaine, heroin, illicit methadone, other narcotics, marijuana, inhalants, downers, PCP, methamphetamine, hallucinogens, downers, and other drugs.
Ramin Mojtabai and Joshua Graff Zivin. 2003. “Effectiveness and Cost‐effectiveness of Four Treatment Modalities for Substance Disorders: A Propensity Score Analysis.” In Health Services Research, 38(1p1): 233-259.