Costs, benefits, and net benefit of 13 inpatient substance use treatments for 14,947 women and men

In an attempt to replicate earlier findings that substance use disorder treatment (SUDTx) has monetary outcomes (benefits) for taxpayers that exceed treatment costs several times over for the average participant, costs of SUDTx were contrasted to observed costs of healthcare, criminal justice services, and economic assistance, plus potential increases in earned income, for 14,947 substance-using individuals treated at 13 intensive inpatient programs varying in gender sensitivity. Those who received higher levels of gender-sensitive treatment were expected to better offset treatment costs through greater reductions in subsequent service costs and economic assistance, and greater increases in earned income. Compared to the 24 months preceding treatment, archival data from state databases showed that use of health and criminal justice services, and receipt of economic assistance, actually increased during the 24 months following treatment, and that earned income decreased, resulting in unexpectedly negative net benefits, i.e., a net loss, from a taxpayer perspective. More gender-sensitive treatment was less costly per participant, however, making the net loss less for persons receiving more gender-sensitive treatment. Alternative explanations for these findings are explored, including utilization of archival records of service use rather than the more bias-sensitive self-reports of service use that others have examined previously. The importance of evaluating nonmonetary, as well as monetary, outcomes of substance use disorder (SUD) treatment is noted as well.