Final report
Prepared under Contract HHS-100-95-0036
U.S. Department of Health & Human Services
Office of the Assistant Secretary for Planning and Evaluation


Dean R. Gerstein, Robert A. Johnson, and Cindy L. Larison
National Opinion Research Center
at the University of Chicago
Henrick J. Harwood and Douglas Fountain
The Lewin Group
Fairfax, Virginia

January 1997

Table of Contents


The authors greatly appreciate the advice and the firm but gentle guidance we received from Laura Feig and Sharman Stephens of the Department of Health and Human Services, the thoughtful review comments provided by other staff in the Department; and the support and inspiration of Peter Edelman formerly the Assistant Secretary for Planning and Evaluation. We continue to be grateful to the State of California, particularly Susan Nisenbaum and Andrew Mecca of the Department of Alcohol and Drug Programs; the NORC project staff, especially Natalie Suter and Kathryn Malloy; and more than 1,800 participants in treatment whose cooperation with this study made CALDATA possible.
Copies of this report may be requested in writing from:
U.S. Department of Health and Human Services
Office of the Assistant Secretary for Planning and Evaluation
Division of Children and Youth Policy
200 Independence Avenue, SW
Room 450G
Washington, DC 20201

Or requests may be faxed to: 202-690-5514

Internet site: http://aspe.hhs.gov/hsp/cyphome.htm

LIST OF FIGURES

LIST OF TABLES

EXECUTIVE SUMMARY

1. INTRODUCTION

2. DATA SOURCE: ABOUT CALDATA

3. CHARACTERISTICS OF TREATMENT SUBGROUPS

4. TREATMENT EFFECTS

5. TREATMENT COSTS AND BENEFITS

6. SUMMARY


Many persons in substance abuse treatment, especially women, were parents, welfare recipients, or both
Women, parents, and welfare recipients improved after treatment
Measurable treatment benefits exceeded treatment costs for each group of special interest

This report analyzes the outcomes, costs, and benefits of substance abuse treatment that is, treatment for drug or alcohol problems for two partially overlapping groups that are of special interest to social welfare agencies: parents of children under 18 years of age and recipients of public income support such as Aid to Families with Dependent Children (AFDC). The primary data source is CALDATA, a study of treatment outcomes in a random sample of persons (N=1,825) representing approximately 150,000 individuals who during 1991-92 received drug and alcohol treatment and recovery services in California. Key results of this analysis of the drug and alcohol treatment population were as follows:

Many persons in substance abuse treatment, especially women, were parents, welfare recipients, or both:

  • Slightly more than one-third (36%) of the California treatment population had children living with them prior to treatment.

  • About half of those with children were men and half were women. There were substantially more men than women in treatment, but women were proportionately much more likely to have children or express parenting concerns:
    • Nearly half of the women in treatment had children in the household compared with less than one-third of the men (47% versus 29%).

    • More than three times as many women as men cited parenting concerns as a reason for entering treatment (28% versus 8%).

    • Altogether, 56 percent of the women in treatment had children in the household or cited parenting concerns as reasons for treatment, compared with 33 percent of the men.

  • About 41 percent of all the women in treatment and 64 percent of the women with children in their households received welfare income in the year before treatment; by comparison, about 18 percent of men and 23 percent of men with children received welfare.

Women, parents, and welfare recipients improved after treatment:

  • The beneficial outcomes of treatment for substance abuse were similar for men, women without children, and women with children, including those who received welfare income.

  • Compared with the year before treatment, the number of substance users after treatment among women with children who received welfare income dropped by about 39 percent for crack cocaine, 42 percent for cocaine powder, 48 percent for amphetamines, 14 percent for heroin, and 26 percent for alcohol. (For the purposes of these analyses "substance user" was defined as someone who had used the substance five or more times in the past year.)

  • Among women with children who received welfare income, comparing the year before and the year after treatment:
    • The percentage who engaged in one or more illegal activities per annum dropped by about 67 percent, the percent who sold or helped to sell drugs fell by about 60 percent, and the percent who were arrested, booked, or taken into custody dropped by about 54 percent.

    • The percentage hospitalized during the course of one year dropped by about 58 percent.

    • The percentage who were homeless for two days or more dropped by about 61 percent.

Measurable treatment benefits exceeded treatment costs for each group of special interest:

  • The benefits of treatment as measured from the point of view of taxpayers included reductions in crime, transfer payments, and health care expenditures. These benefits outweighed the costs of treatment for those who received welfare income, were raising children, or expressed parenting concerns as reasons for seeking treatment.

  • An average treatment episode lasted about three months, cost about $1,400, and yielded benefits to taxpayers during and after treatment worth about $10,000, with the greatest share of benefit deriving from reductions in the economic burden of crime.

  • The measured benefit to taxpayers exceeded the cost of treatment by 6 to 1 for women with children who did not receive welfare and 2 to 1 for women with children who did receive welfare. The benefits of treatment were lower among women than men, and especially among women who were parents or received welfare, principally because these women initially committed less crime than men.

  • The role of treatment in moving persons from economic dependency to greater self-support was difficult to evaluate in CALDATA, because overall unemployment rose steadily in California throughout the period under study, from about 5.6 percent to 9.2 percent, and the treated population worked largely in occupations that were disproportionately vulnerable to employment fluctuations.

From the standpoint of social welfare policy, particularly as it bears on families, we believe these results provide clear encouragement to support treatment options. Our benefit estimates are conservative, because they do not quantify the improved life chances of the children of treated parents or measure continuing benefits sustained beyond the first year after treatment. While treatment does not help everyone, it appears to be a widely useful and cost beneficial instrument for policy for those concerned with the welfare of families or individuals receiving public income support.

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