Can Encouraging Substance Abuse Patients to Participate in Self-Help Groups Reduce Demand for Health Care? A Quasi-Experimental Study

Authors

  • Keith Humphreys,

    Corresponding author
    1. Center for Health Care Evaluation and Program Evaluation and Resource Center, Veterans Affairs Palo Alto Health Care System, and the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.
    Search for more papers by this author
  • Rudolf Moos

    1. Center for Health Care Evaluation and Program Evaluation and Resource Center, Veterans Affairs Palo Alto Health Care System, and the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.
    Search for more papers by this author

  • Supported by the Department of Veterans Affairs Mental Health Strategic Health Group, Health Services Research and Development Service, and a VA Young Investigator Award (KH).

Reprint requests: Dr. Humphreys, Stanford University School of Medicine, VAPAHCS (152-MPD), 795 Willow Road, Menlo Park, CA 94025; Fax: 650-617-2736; E-mail: knh@stanford.edu

Abstract

Background: Twelve-step-oriented inpatient treatment programs emphasize 12-step treatment approaches and the importance of ongoing attendance at 12-step self-help groups more than do cognitive-behavioral (CB) inpatient treatment programs. This study evaluated whether this difference in therapeutic approach leads patients who are treated in 12-step programs to rely less on professionally provided services and more on self-help groups after discharge, thereby reducing long-term health care costs.

Methods: A prospective, quasi-experimental comparison of 12-step-based (N = 5) and cognitive-behavioral (n= 5) inpatient treatment programs was conducted. These treatments were compared on the degree to which their patients participated in self-help groups, used outpatient and inpatient mental health services, and experienced positive outcomes (e.g., abstinence) in the year following discharge. Using a larger sample from an ongoing research project, 887 male substance-dependent patients from each type of treatment program were matched on pre-intake health care costs (N = 1774). At baseline and 1-year follow-up, patients’ involvement in self-help groups (e.g., Alcoholics Anonymous), utilization and costs of mental health services, and clinical outcomes were assessed.

Results: Compared with patients treated in CB programs, patients treated in 12-step programs had significantly greater involvement in self-help groups at follow-up. In contrast, patients treated in CB programs averaged almost twice as many outpatient continuing care visits after discharge (22.5 visits) as patients treated in 12-step treatment programs (13.1 visits), and also received significantly more days of inpatient care (17.0 days in CB versus 10.5 in 12-step), resulting in 64% higher annual costs in CB programs ($4729/patient, p < 0.001). Psychiatric and substance abuse outcomes were comparable across treatments, except that 12-step patients had higher rates of abstinence at follow-up (45.7% versus 36.2% for patients from CB programs, p < 0.001).

Conclusions: Professional treatment programs that emphasize self-help approaches increase their patients’ reliance on cost-free self-help groups and thereby lower subsequent health care costs. Such programs therefore represent a cost-effective approach to promoting recovery from substance abuse.

Ancillary