Substance abuse treatment, what do we know? An economist's perspective

The literature on treating substance abuse has dealt basically with four important questions: (a) Is treatment effective? (b) Are all programs equally effective? (c) Why do programs differ in their effectiveness? (d) Which treatments are more cost-effective? This paper reviews the substance abuse treatment literature around these four questions and discusses methodological issues that hinder the interpretation and generalization of results to date. The answer to the first question is a sounding "yes," treatment is effective but not all programs are equally effective. Researchers have moved beyond the "black box" literature that concentrated on patient and program characteristics as explanations for differences in effectiveness and search for the "active" ingredients of treatment. These include, for example, the treatment philosophy of the program's director and staff attitudes towards patients. Cost-effectiveness studies are less common, and their conclusions are mixed. In general, it is probably safe to say that for the majority of patients, outpatient or shorter programs are more cost-effective.