As increasing numbers of individuals enter treatment for substance abuse and dependence, an era of cost containment challenges the cost effectiveness of traditional inpatient care. Clinical studies suggest that outpatient treatment for alcohol abuse and dependence may be as effective as inpatient treatment and is generally much less expensive, but few studies have included more severe patients or studied less costly non- hospital-based residential treatments. Further, it remains costly to provide chemical dependency treatment services even in the outpatient setting. In response to the challenge of providing cost effective wraparound services for patients with severe problems and high relapse potential, a large Health Maintenance Organization (Kaiser Permanente) has recently contracted with residential recovery programs to provide a new residential benefit. This study undertakes a controlled, random assignment comparison of 768 patients eligible for the new benefit. Subjects will be assigned to one of two treatment settings--intensive outpatient (19 group sessions per week) or residential recovery (20 group sessions per week)--to enable comparison of two types of treatment available in a """"""""real world"""""""" HMO (Kaiser Permanente Southern California) serving a heterogenous population (33 percent women, 22 percent Black, 14 percent Hispanic) reflective of many urban communities. Using an intent-to-treat model, the study considers independent variables including during-treatment service mix/intensity, retention, informal peer helping, and use of aftercare, as well as post- treatment outcome and improvement rates in abstinence, drug use and alcohol consumption, medical and psychiatric problems, and employment, legal and family/social problems. Ethnographic observation will augment the survey data. Since a central goal of both treatments is fostering strong affiliation with groups such as AA/NA/CA, the project will consider variables such as social network support for abstinence and affiliation with 12- step programs; their role in the causal pathway to abstinence will also be assessed. The study will measure patient utilization of health and social services including Kaiser Permanente medical services utilization one year prior to and one year following treatment, and will also compare costs of providing each treatment. The relative cost effectiveness of intensive outpatient and residential recovery under managed care will be analyzed. The study will confirm treatment content and will identify patient characteristics associated with successful treatment outcomes in each setting.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA012297-02
Application #
6174882
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Denisco, Richard A
Project Start
1999-09-25
Project End
2004-08-31
Budget Start
2000-09-01
Budget End
2001-08-31
Support Year
2
Fiscal Year
2000
Total Cost
$567,726
Indirect Cost
Name
Public Health Institute
Department
Type
DUNS #
128663390
City
Oakland
State
CA
Country
United States
Zip Code
94607
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Kaskutas, Lee Ann; Zavala, Silvana K; Parthasarathy, Sujaya et al. (2008) Costs of day hospital and community residential chemical dependency treatment. J Ment Health Policy Econ 11:27-32
Zemore, Sarah E; Kaskutas, Lee Ann (2008) 12-step involvement and peer helping in day hospital and residential programs. Subst Use Misuse 43:1882-903
Zemore, Sarah E (2007) A role for spiritual change in the benefits of 12-step involvement. Alcohol Clin Exp Res 31:76s-79s
Witbrodt, Jane; Bond, Jason; Kaskutas, Lee Ann et al. (2007) Day hospital and residential addiction treatment: randomized and nonrandomized managed care clients. J Consult Clin Psychol 75:947-59