The Value of Vocational Rehabilitation in Substance User Treatment: A Cost-Effectiveness Framework

Abstract

Vocational rehabilitation (VR) programs within addiction treatment traditionally consider employment as the desired outcome. This singular focus ignores other benefits, such as reduced substance use. A framework for evaluating the cost-effectiveness of VR within addiction treatment is presented and illustrated with data from the Alcohol and Drug Services Study (ADSS, 1996–1999). VR was associated with a 2.5% increase in probability of abstinence at an $883 increase in cost per admission. Thus, the estimated cost-effectiveness of VR in promoting abstinence is $35,000 per additional abstinent client ($883/0.025), indicating that VR is a cost-effective contributor to other goals of addiction treatment.

• Vocational rehabilitation
• Cost-effectiveness
• Employment
• Outcomes
• Substance use

Additional information

Notes on contributors

Donald S. Shepard

Donald S. Shepard, Ph.D., is Professor at the Schneider Institute for Health Policy at the Heller School, Brandeis University. Director of the Institute's Cost-Effectiveness Group, he is a health economist concerned with health problems of both the United States and developing countries. His major concentrations are cost and cost-effectiveness analysis in health, and health financing. After receiving his B.A. magna cum laude with highest honors at Harvard, Dr. Shepard earned a Master of Public Policy and a Ph.D. in Public Policy from the Kennedy School of Government at Harvard University. Particularly interested in the cost-effectiveness of new technologies, he is a member of Board of Councilors for the Pediatric Dengue Vaccine Institute and the Board of Scientific Advisors of the Sabin Vaccine Institute, both dedicated to new and improved vaccines. He served as a member of peer review “study section” that reviews grant applications to the National Institutes of Health in health services research for scientific merit. With funding from the Massachusetts Division of Medical Assistance and the National Institutes of Health, he was Principal Investigator (PI) or Co-PI of the evaluation of a restructuring of mental health and substance user services in the state. He is the lead evaluator of two national demonstrations for the Medicare Program. Prof. Shepard's research focuses on the cost-effectiveness of alternative approaches to substance user treatment, lifestyle modification, prescription drug coverage, and AIDS care. He also holds adjunct or visiting faculty appointments at the Boston and Brown Universities.

Sharon Reif

Sharon Reif, Ph.D., is a Senior Research Associate at the Schneider Institute for Health Policy at Brandeis University. Dr. Reif received her Ph.D. in social policy from the Heller School for Social Policy and Management at Brandeis University in 2002; her dissertation examined the role of ancillary services in substance abuse treatment outcomes. She received a training grant from the National Institute of Alcohol Abuse and Alcoholism (NIAAA) while in the doctoral program at the Heller School. She has over 14 years of experience in the field of substance abuse research, including project management, client interviews, data analysis, and manuscript preparation. Recently, Dr. Reif was the project manager for an RWJ grant covering ongoing analyses of the Alcohol and Drug Services Study (ADSS), with a focus on the specialty substance abuse treatment system, and the clients within that system. This work stemmed out of her participation under the original contract to conduct and perform analyses for ADSS. Dr. Reif is currently the project manager on a CSAT study of the relationship of financiang and cost issues with access to substance abuse treatment. Her primary research interests center around what happens to clients in and following substance abuse treatment.