Published Spring 2019, Version 1.0
(Download a .pdf of this article at the bottom of the webpage)
Historically, major illnesses that lead to death have shifted since the beginning of the Twentieth Century as a result of effective public health interventions. For example, infectious diseases were once a leading cause of death; however, this changed as improved sanitation and immunizations were implemented as effective forms of prevention. The National Institute on Drug Abuse (NIDA; 2017) stated, “There are more deaths, illness, and disabilities from substance use than from any other preventable health condition”. Research conducted on substance use disorder prevention suggests that there are effective evidence-based prevention strategies in existence, but grossly underutilized.
Nationally, substance use costs the United States over 600 billion dollars annually (NIDA, 2018). Research has found that individuals with substance use disorder are representative of some of the highest-cost users of health services, including more frequent and longer durations of hospitalizations (Hostetter & Klein, 2017). More than 115 people die in the United States every day after overdosing on opioids (Centers for Disease Control, 2017). This is a trend that is expected to continue to rise and is associated with a significant cost. Specifically, the Centers for Disease Control (CDC; 2017) reported that an estimate solely for prescription opioid misuse could result in an “economic burden” of over $78.5 billion per year in the United States.
Figure 1. Retrieved from https://www.commonwealthfund.org/publications/newsletter-article/2017/sep/focus-expanding-access-addiction-treatment-through-primary
What is Substance Use Disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), substance use disorders are defined as the reoccurring presence of alcohol and/or drug use that causes significant impairments. Levels of severity are indicated by diagnostic criteria and categorized as mild, moderate, or severe.
Substance Use Prevention
Prevention planning and programs are structured on the Strategic Prevention Framework (SPF), which consists of a five-step process that addresses substance use disorder (SAMHSA, 2017). The SPF exhibits the following essential prevention qualities: (a) accountability; (b) capacity; and (c) effectiveness. Furthermore, the U.S. Department of Health and Human Services (2017) discussed the principles that guide the SPF provide evidence-based benefits and include:
- Prevention is a continuum;
- Prevention is prevention is prevention;
- Successful prevention decreases risk factors and enhances protective factors;
- Prevention strategies use proven and evidence-based practices;
- Collaborative systems of prevention services are more effective than isolated prevention efforts;
- Importance of sharing of information, tools, and strategies across systems are beneficial;
- And substance use should be addressed in a comprehensive method.
Return on Investment: Prevention’s Worth
Evidence-based prevention for individuals with substance use disorder is effective in reducing costs associated at the individual, societal, and national health levels. Research regarding cost-benefits associated with substance use prevention has indicated that for every $1 spent on substance use prevention there is a yield of $10 return to long-term savings of treatment costs alone (Hahn-Smith, 2011).
School-based prevention research was conducted assessing cost-benefits and found that if effective school-based prevention programs were implemented nationwide, then for every $1 invested would yield $18 back in savings (Miller & Hendrie, 2008). Furthermore, the Southwest Prevention Center (2004) completed an intensive literature review of studies conducted regarding the cost-benefits of prevention of substance use. There were significant findings that included:
- Return on investment of prevention programs included $2-$20 for every dollar spent on prevention programs;
- Every study available at the time of the review consistently found cost-benefits of prevention programs for substance use by at east two to one.
Cost-benefit studies regarding prevention indicate that for every dollar spent on substance use prevention can result in ten dollars in long-term savings.
Although financial gains exist in investing in prevention, intangible benefits also exist that increase the overall worth of prevention. Research findings listed examples of these benefits and include:
- lower crime rates;
- increase in productivity;
- decrease in motor vehicle accident rates;
- increase in overall life expectancy;
- and higher employment rates.
Investing in prevention related to substance use disorders is proven to have significant impacts at the individual, societal, and health levels. The availability of evidence-based prevention programs exists and requires the utilization of available prevention programs and strategies.
As a statewide agency, The North Carolina Training and Technical Assistance (NCTTA) Center provides workforce development, training, and technical assistance opportunities to substance abuse prevention stakeholders. Funding for the NCTTA is provided by the N.C. Department of Health and Human Services, Division of Mental Health, Developmental Disabilities and Substance Abuse Services with funding from Substance Abuse and Mental Health Services Administration. To learn more visit ncpreventiontta.org
Substance Abuse and Mental health Services Administration (2017). Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis, Retrieved from: http://www.samhsa.gov/sites/default/files/cost-benefits-prevention.pdf.
Centers for Disease Control and Prevention (2017). Contribution of Excessive Alcohol Consumption to Deaths and Years of Potential Life Lost in the United States. Retrieved from http://www.cdc.gov/pcd/issues/2014/13_0293.htm.
Hostetter, M., & Klein, S. (2017). In focus: Expanding access to addition treatment through primary care. The Commonwealth Fund: New York, NY.
Miller, T. R., & Hendrie, D. (2008). Substance abuse prevention dollars and cents: A cost-benefit analysis. DHHS. Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration.
National Institute on Drug Abuse (2017). Health consequences of drug misuse. Retrieved from https://www.drugabuse.gov/related-topics/health-consequences-drug-misuse
U.S. Department of Health and Human Services. Surgeon General’s 2016 Report on Alcohol, Drugs, and Health. Retrieved from https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf.
University of Oklahoma (2004). Cost-benefit of prevention: Review of research literature. Southwest Prevention Center, 1-4.