Prevention of Substance Abuse Essay

This project aims to define and establish issues presented by substance abuse and relapse. It will then be discussed that an intervention is needed, followed by the estimated financial impact the intervention in question will have on the organization. Substance abuse is the immoderate consumption of a substance, especially alcohol or a drug over a prolonged amount of time (Shriel, 2018). This phenomenon has many consequences including but not limited to social withdrawal, poor work or school performance, inability to stop using the substance, inability to perform daily functions such as driving, and legal problems(i.e. getting arrested for substance-related disorderly conduct(Shriel, 2018). It is that having individuals plagued by substance abuse is all but beneficial to any organization.

The proposed project aims to reduce substance abuse problems by preventing relapse. The purpose of this paper is to address the cost-benefit of this project and analyze its resource expenditures relative to the risks/benefits of this project’s initiative. The cost analysis helps set priorities and gain more clarity on the decision-making process in determining the benefits when choices are limited (Waxman, 2012). The cost-effectiveness analysis (CEA) compares the costs and the values of various healthcare interventions; this analysis can help to evaluate improvement in healthcare outcomes and justifies the expenditures spent on these mitigations (Waxman, 2012). Lastly, the project will assess if the cost of the projected implementation will be covered over time.

Background on the Project

Recent findings from the NESARC indicate that about 2.0% of adults living in US households had a DSM-IV drug use disorder in the prior 12 months (1.4% abuse, 0.6% dependence), and 10.3% reported a drug use disorder at any point in their lifetime (7.7% abuse, 2.6% dependence). In addition, drug abuse and dependence were associated with significant disability, including missed work days and repeated hospitalizations( Schulden, et al 2011). An application of these numbers is as follows: In the 328,2 million US population, about 6 million 5 hundred and 4 thousand had a drug use disorder. Those are staggering numbers obtained in the years just before 2011. In 2017, according to the National Survey on Drug Abuse and Health(NSDUH), 19.7 million American adults alone battled with substance abuse. Almost 74% of them struggled with alcohol abuse and 38% with an illicit drug(SAMHSA, 2017). These sets of statistics suggest that the country is faced with a developing health problem, that needs serious attention.

The proposed intervention will take the form of an evidence-based performance combination of medication-assisted treatment(MAT) and behavioral therapy. The aim is further to ensure that the improvements are life-long. The importance of this kind of project is two-fold as it not only contributes to the health of the participants(in this case members of the organization) but also adds to the existing international body of knowledge regarding the prevention and management of substance abuse and relapse. Ideally(based on existing knowledge), this treatment will occur on an outpatient basis as opposed to inpatient treatment- unless the practitioner deems it fit to escalate the patient's treatment to the ‘inpatient basis”. The outpatient form of treatment ranges from about 30-120 days(Hubbard et al, 1989, 1997). This may begin with full or half-day sessions, five or more times a week for approximately a month. As the treatment progresses, the duration and intensity of the sessions decrease. These sessions typically include group sessions, therapy, team building exercises, educational seminars, guidance and support for behavioral changes, and a whole lot of other modes of treatment catered to every individual's needs. As has been mentioned before, one of the aims is to add to the existing body of knowledge, therefore the aforementioned treatment modalities will aim to be improved, while new evidence-based ones(more efficient and effective) are being explored.

Cost Benefit Analysis

Cost-benefit analysis directly compares benefits to costs in terms of money by assigning dollar value to all important outcomes, including death, opportunity cost, and health outcomes. Reporting costs and results as a common metric makes comparisons between different programs easier and a clear distinction between costs and benefits. In addition to reporting the cost-benefit ratio, the cost-benefit analysis usually provides a net benefit estimate, which is the benefit of the intervention minus the cost of the intervention (Mishan,2018). For example, the cost-benefit ratio for the relapse prevention program is 2: 6 (see table below). This means you can save $2 for every dollar invested, in program cost there is $6 in return. Cost-benefit analysis shows that programs save more than it costs to develop and deliver however, other factors must also be considered, such as the level of outcome and long-term effects. When allocating resources, analysts often make a compromise between the most efficient investments, i.e. those with the highest cost-to-benefit ratio and those with a wider range that can generate a greater total profit.

The basic concept of present value discount cost-benefit analysis is that intervention delays or prevents costs this year and in the future. If the program has to pay $1 in 5 years, you can invest less than $1 today to cover that cost (Hargreaves et al., 2018). A generally accepted practice is to adjust future costs to their present value by applying a discount rate (Gold et al., 2016). Discount rates are essentially the opposite of interest rates. Whenever possible, this report uses a 3% discount rate recommended by the Health and Medicine Cost Effectiveness Panel and the U.S. Bureau of Management and Budget. As recommended, this ratio is used to discount all future costs and benefits, including QALY profits.

Costs

The following section describes the cost of implementing the project. The success of this proposition needs commitment from the practitioners at the implementation site. The idea is to ensure this commitment through value-based purchasing for the quality services of the practitioners. With that in mind, a base salary will be provided and the value of the work performed can optimize the pay, in order to ensure quality while compensating the practitioners for income lost in their individual practices while working on the project. Other personnel as well as equipment also need to be considered when calculating possible expenditures. The total duration of the project will span about 2 months. The health practitioners will cost about $20000, the typists about $700, research assistants about $650, equipment such as printers, projectors, chairs, writing boards, etc, about $500, the consultants such as specialists, $1050, supplies such as a pens and papers will be about $450 and other unforeseen additional costs will be about $1000- bringing the total budget to about $24350. The following table demonstrates the total budget :

Category Amount

• clinical practitioners $20000
• typist $700
• Research assistants $650
• equipment $500 consultants $1050
• supplies $450
• other $1000
• total $24350

The Benefits

A well-implemented substance relapse prevention program can have considerable success. Example: Washington State Screening, Brief Intervention, and Referral to Treatment (WASBIRT) found significant medical cost savings among 1,315 disabled Medicaid clients who were mediated through the program. The administrator concluded that the potential reduction in Medicaid costs could be as high as $2.8 million per year for working-age disabled clients receiving short-term intervention. Based on these same estimates, our project can result in savings of a minimum of 1.8 million a year on Medicaid, health insurance, and hospitalization costs.

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Certain Medicaid benefits for this project include $185 per month per member after simple intervention. For instance, the cost of attending a substance abuse rehabilitation program on average is $500 per month. We anticipate that the project will reduce relapses and eliminate lower down cost to $185 a month. Savings of $315 dollars per person. And the costs associated with hospital stays from emergency room admissions are $238-$269 per month per member. The project also aims to increase savings by fewer hospital stays due to emergency room visits when a person addicted to substances gets involved in accidents after a relapse. The project goal is to have at least 0-5 hospital stays for a minimum of fifty people who attend the intervention.

The Economic Benefits of Intervention

Research shows that spending $1 on relapse prevention programs saves $4 in healthcare costs and $7 in law enforcement and other criminal justice costs. On average, the cost of substance abuse treatment is $1,583 per patient and the cost offset is $11,487, indicating a cost-to-benefit ratio of 7:1 or higher ( ) Some states have found that providing adequate mental health and relapse prevention benefits can significantly reduce medical costs and Medicaid spending. A study of alcohol and substance abuse treatment programs in Washington State found that providing full addiction treatment benefits saved $398 per month on Medicaid spending per patient.

Medical bills for those receiving treatment were $311 lower per month than for those who needed treatment but did not receive it, and state hospital costs for those in treatment were as low as $48 per month. The likelihood of arrest for those receiving treatment was reduced by 16% and the likelihood of convicting a felony convicted was reduced by 34%, further contributing to the state's cost savings. According to a California study, more than 70% of the expected cost of alcohol abuse may be due to decreased productivity. These results suggest that understanding the impact of relapse prevention in the workplace can be of significant value to employers. These statistics show that implementing a relapse prevention program can save you more than $8,200 in healthcare and productivity costs.

Financial Incentives

Apart from the cost of resources computed in the table above, there are other costs of financial incentives that will be incurred to motivate patients to prevent relapse. Incentive programs, including low-cost programs, add excitement and additional reasons for attending substance abuse treatment ( ). Many substance abusers are ambivalent about treatment, and compensation can help them continue to participate in counseling. Extending the duration of the treatment can extend abstinence, in part because it gives the counselor more time to re-engage in a drug-free lifestyle, Helping patients remain abstinent after leaving treatment is a challenge for any treatment, and incentive programs will motivate patients not to relapse.

While some previous clinical trials for voucher-based incentive programs have shown treatment effects lasting for a year or two, others have found no added value in the long run compared to conventional treatments. In most early studies, patients always received vouchers that could be exchanged for goods or services, rather than an opportunity to receive goods for their positive behavior. This project aims to implement the same program as an incentive for patients to avoid relapse. The incentives will be in the form of electronic gadgets for those whose behavior change has been successful in 3 months. Costs of such will typically amount to approximately $1,000 per patient over three months.

However, the implementation of this project will have more benefits than the total cost of $ 25,350 incurred in implementing the project. This is because the project will bring a return on investment as calculated in the figure below.

Return on Investment (ROI), is a standard metric used to evaluate the forecasted profitability of different investments to determine if the need is beneficial (Calculator.net, 2020). The QI project will include a recruit and include 30 patients; hypothetically if the 30 patients had imaging at $130.00 and reimbursement from Medicare for an abnormal screening at $1000.00, the ROI is 87%. The finance calculator ROI used to conduct the cost-benefit analysis is displayed in the below table:

• Amount invested - imaging
• Amount returned - medicare
• Investment time 1-may-20

Conclusion

The cost and benefits of health care issues will always be steep but the benefits are potentially lifelong and could benefit generations to come. Presented before you is an opportunity to chiefs in the research of the management and prevention of substance abuse and relapse.