The cost-effectiveness of alcohol and other drug treatment is an important issue in current welfare policy discussions for two principal reasons. First, substance abuse by parents may have serious and potentially indelible effects on their children. Substance abuse by parents may increase the risk of retardation, learning impairments, poor school achievement, physical and emotional neglect and abuse, and, of course, the specific risk that children will themselves proceed to abuse alcohol or other drugs.
In recent years teachers have reported an increasing number of children who display troubling behaviors and learning problems that they suspect may be related to the effects of substance abuse either prenatal exposure to alcohol or other drugs or the consequences of living in families and communities where substance abuse is common. Children exposed to adult substance abuse are more likely than other children to display problem behaviors such as short attention span, extreme distractibility, speech and language disorders, aggressive and disruptive behavior, and social incompetence.1 While it is difficult, and beyond the scope of this report, to quantify the costs to society of the reduced prospects for productive lives of children exposed to adult substance abuse, research suggests that these intergenerational effects are likely to be large.
The second reason for human service agency interest in substance abuse treatment is that substance abuse has been identified as a barrier to economic self-sufficiency. Two 1994 HHS reports used data from the National Household Survey on Drug Abuse (NHSDA) to show the following:
- 10.5 percent of persons aged 15 and older in Aid to Families with Dependent Children (AFDC) households reported past month illicit drug use.
- 5.2 percent of adults in AFDC households had significant alcohol or other drug abuse problems that may be sufficiently debilitating to preclude immediate participation in employment or training activities
- 11.2 percent of adults in AFDC households were somewhat impaired by alcohol or drug use and might need substance abuse treatment concurrent with participation in employment and training activities.2 In addition, the National Longitudinal Alcohol Epidemiologic Survey indicated that 9.6% of adult men and 7.3% of adult women who received welfare assistance were dependent on alcohol and 5.6% of men and 3.3% of women who received welfare abused or were dependent on illicit drugs.3
The body of this report presents data on the outcomes, costs, and benefits of recovery services for substance abuse in California with a special focus on alcohol and other drug treatment outcomes for parents and recipients of public income support, and particularly women with children who received welfare income the main concern of the federal AFDC program. Our primary source of data is the California Drug and Alcohol Treatment Assessment (CALDATA). During 1992-1994, under contract to the California Department of Alcohol and Drug Programs, a research team at the National Opinion Research Center and Lewin-VHI (now The Lewin Group) designed and performed CALDATA and authored the study's widely known report, Evaluating Recovery Services4. CALDATA was designed to reveal baseline, in-treatment, and post-treatment characteristics of a representative probability sample of 1991-92 clients in the four major types of treatment available to California residents who are eligible for public support such as MediCal (California's Medicaid program), state/county alcohol and drug treatment contract funding, or public disability insurance. CALDATA estimated that substantial savings accrued to taxpayers, in the neighborhood of $7 saved for each dollar invested in treatment, as a reasonably attributable result of alcohol and drug treatment, primarily in reduced crime and reduced health care costs.
Approximately 36 percent of the treatment population of nearly 147,000 individuals represented by CALDATA were living in households with children under 18 years of age. About 38 percent of the treatment population were women, and more than 27 percent reported receipt of AFDC or other welfare income before, during, or after treatment. However, the original CALDATA analyses did not attend specifically to subgroups such as parents or welfare recipients. The research began with no prima facie reasons to expect that parents or individuals receiving welfare income would respond to substance abuse treatment differently than other treatment clients. Previous CALDATA analyses indicated that, by and large, women responded to treatment about the same as men, although there were a few indicators on which the analysis did suggest less satisfactory outcomes of treatment, particularly in terms of health care utilization and economic dependency. For measures of criminal activity, women showed smaller percentage declines in criminal activity, resulting largely from the lower aggregate pre-treatment levels of crime among the women.
Chapter 2 of this report briefly describes CALDATA, including the types of treatment covered. Chapter 3 defines and characterizes the treatment subgroups analyzed in this report. Chapter 4 discusses treatment outcomes in terms of drug and alcohol use, income sources, employment, criminal activity, and health status and health care utilization. Chapter 5 furnishes economic estimates of the benefits and costs of treatment from the point of view of taxpayers. Chapter 6 summarizes the main points of the study.