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Treatment Effectiveness

Does treatment work? This issue is complex but extremely important, given the time and expense of alcohol and other drug treatment and the costs to society when people continue abusing alcohol and other drugs following treatment. Although numerous studies have examined treatment effectiveness, making sense of the results is difficult because of several underlying problems.

Problems

Treatment programs, for the most part, are not designed to scientifically evaluate the aspects of treatment that are most effective. This makes research immediately problematic, as there is no control over the many variables that may affect results. The numerous client variables that may impact treatment effectiveness include age, gender, duration of use, type of substances used, life problems experienced, voluntary or involuntary admission to treatment, prior treatment, client health, psychological problems, criminal activity, level of education, and income. The type of treatment environment (e.g., private, for profit; public, nonprofit; hospital inpatient; free-standing outpatient; therapeutic community) may impact effectiveness. To adequately research the effectiveness of a treatment program or treatment approach, a control group is necessary. Ethical (and practical) issues in the random assignment of clients to treatment must be considered when the researcher hypothesizes that one form of treatment is superior to another.

Equally as important to the issues that create barriers to well-designed research studies are the types of outcomes in effectiveness studies. Is client success defined by program completion, abstinence, length of sobriety, reduction in life problems, or all of these factors? What if a client completes a program, relapses, goes to a different program, and then remains abstinent? Does that mean the first program was a failure, or, on the contrary, did it contribute to the client's eventual sobriety?

Treatment Outcome Studies

Fortunately, major long-term studies have been completed to help answer the question "Does treatment work?" The Center for Substance Abuse Treatment sponsored a congressionally mandated study of treatment outcomes for clients in public-sector treatment programs. The National Treatment Improvement Evaluation Study followed 4,411 clients in 78 treatment sites across the country for 5 years; the results were first published by Dean Gerstein in 1997. Clients were from vulnerable and underserved populations, such as minorities, pregnant women, youth, public housing residents, welfare recipients, and those involved in the criminal justice system. Many of the people studied did not complete treatment, which would tend to depress any positive results. In spite of these factors, there were significant reductions in alcohol and other drug use 1 year after treatment regardless of the amount of time spent in treatment or the amount of treatment received. In addition, positive outcomes were found in employment income, mental and physical health, criminal activity, homelessness, and high-risk behaviors for HIV infection. This study also demonstrated that the average savings per client in the year after treatment was $9,177, which is more than three times the average cost of one treatment episode. The savings were a result of reduced health care, reduced crime-related costs, and increased earnings by clients. Outpatient and long-term residential treatment showed the largest cost savings, but short-term residential treatment and outpatient methadone also were cost-effective.

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