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Ted R. Miller, PhD, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705-3102, 301/755-2727, miller@pire.org and Delia Hendrie, Department of Public Health, University of Western Australia, Nedlands, Western Australia, 6907, Australia.
Background: The literature contains scattered estimates of substance abuse prevention cost savings and richer, more comparable return on investment estimates for reducing impaired driving, violence, and other immediate harms associated with alcohol and drug use. Methods: We searched the literature for estimates, recomputed benefits and costs as necessary, and created a league table showing consistent benefit-cost ratios and costs per quality-adjusted life year (QALY) for 76 interventions. We also computed eight new cost-outcome estimates, most of them for family-centered or school-based behavioral programs (Project Alert, Project Northland, etc.). We arrayed the interventions once by problem addressed (initiation, excess consumption, fires, etc.) and again by approach (behavioral, clinical, physical environment, enforcement, etc.). Results: Family-centered interventions cost more to implement than life skills programs, but also offer a higher return on investment. Many impaired driving and violence interventions are quite cost-effective. Broad injury prevention efforts can be extremely cost-effective because they reduce major harms, not just the subset caused by substance abuse. Conclusions: More than 70 proven interventions are available to reduce substance use or its harmful effects. The challenge is to identify and implement a complementary subset responsive to local problems. Despite their proven returns, measures that may shift drinking to residential settings should be embraced cautiously as their impacts on domestic violence or maximum blood alcohol levels have not been evaluated. Selected consumption-related, violence, and impaired driving interventions are especially appealing because conceptually they address multiple problem behaviors even though their impacts on only a subset have been measured.
Learning Objectives:
Keywords: Economic Analysis, Substance Abuse Prevention
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.