We read and hear about the cost savings of prevention programs, but sometimes it’s important to assess for a specific program and/or collaborative effort.
Quoting the Executive Summary, Section 1, of SAMHSA (Substance Abuse and Mental Health Services Administration) report, “Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis:”
Policymakers and other stakeholders can use cost-benefit analysis as an informative tool for decision making for substance abuse prevention. This report reveals the importance of supporting effective prevention programs as part of a comprehensive substance abuse prevention strategy. The following patterns of use, their attendant costs, and the potential cost savings are analyzed
- Extent of substance abuse among youth;
- Costs of substance abuse to the Nation and to States;
- Cost savings that could be gained if effective prevention policies, programs, and services were implemented nationwide;
- Programs and policies that are most cost beneficial.
1.1. Costs of Substance Abuse
Studies have shown the annual cost of substance abuse to the Nation to be $510.8 billion in 1999 (Harwood, 2000). More specifically,
- Alcohol abuse cost the Nation $191.6 billion;
- Tobacco use cost the Nation $167.8 billion;
- Drug abuse cost the Nation $151.4 billion.
Substance abuse clearly is among the most costly health problems in the United States. Among national estimates of the costs of illness for 33 diseases and conditions, alcohol ranked second, tobacco ranked sixth, and drug disorders ranked seventh (National Institutes of Health [NIH], 2000). This report shows that programs designed to prevent substance abuse can reduce these costs.
1.2. Savings From Effective School-Based Substance Abuse Prevention
If effective prevention programs were implemented nationwide, substance abuse initiation would decline for 1.5 million youth and be delayed for 2 years on average. It has been well established that a delay in onset reduces subsequent problems later in life (Grant & Dawson, 1997; Lynskey et al., 2003). In 2003, an estimated
- 5.6 percent fewer youth ages 13–15 would have engaged in drinking;
- 10.2 percent fewer youth would have used marijuana;
- 30.2 percent fewer youth would have used cocaine;
- 8.0 percent fewer youth would have smoked regularly.
The average effective school-based program in 2002 costs $220 per pupil including materials and teacher training, and these programs could save an estimated $18 per $1 invested if implemented nationwide. Nationwide, full implementation of school-based effective programming in 2002 would have had the following fiscal impact:
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis
- Saved State and local governments $1.3 billion, including $1.05 billion in educational costs within 2 years;
- Reduced social costs of substance-abuse-related medical care, other resources, and lost productivity over a lifetime by an estimated $33.7 billion;
- Preserved the quality of life over a lifetime valued at $65 billion.
Although 80 percent of American youth reported participation in school-based prevention in 2005 (SAMHSA, 2004), only 20 percent were exposed to effective prevention programs (Flewelling et al., 2005). Given this level of participation, it is possible that some expected benefits already exist for these students, and the estimates in this paper are adjusted for these probable benefits. These cost-benefit estimates show that effective school-based programs could save $18 for every $1 spent on these programs.
The cost of substance abuse could be offset by a nationwide implementation of effective prevention policies and programs. SAMHSA’s Strategic Prevention Framework should include a planning step that considers cost-benefit ratios. Communities should consider a comprehensive prevention strategy based on their unique needs and characteristics and use cost-benefit ratios to help guide their decisions. Model programs should include data on costs and estimated cost-benefit ratios to help guide prevention planning.
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