L i B B r r ar y w a t c h on substance use — policy issues — www.ProjectCork.org Spring 2004 Cost-effectiveness analysis of addiction treatment: Paradoxes of multiple outcomes. Sindelar JL; Jofre-Bonet M; French MT; McLellan AT. Drug and Alcohol Dependence 73(1): 41-50, 2004. (40 refs.) This paper identifies and illustrates the challenges of conducting cost-effectiveness analysis (CEA) of addiction treatments given the multiple important outcomes of substance abuse treatment (SAT). Potential problems arise because CEA is intended primarily for single outcome programs, yet addiction treatment results in a variety of outcomes such as reduced drug use and crime and increased employment. Methodological principles, empirical examples, and practical advice are offered on how to conduct an economic evaluation given multiple outcomes. An empirical example is provided to illustrate some of the conflicts in cost-effectiveness (CE) ratios that may arise across the range of outcomes. The data are from the Philadelphia Target Cities quasi-experimental field study of standard versus "enhanced" (e.g. case management and added social services) drug treatment. Outcomes are derived from of the Addiction Severity Index (ASI), while cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program (DATCAP). While the results are illustrative only, they indicate that cost- effectiveness ratios for each of several different outcomes can produce conflicting implications. These findings suggest that multiple outcomes should be considered in any economic analysis of addiction treatments because focusing on a single outcome may lead to inadequate and possibly incorrect policy inferences. However, incorporating multiple outcomes into a CEA of addiction treatment is difficult. Cost-benefit analysis (CBA) may be a preferable and more appropriate approach in some cases. Copyright 2004, Elsevier Scientific Publishers Ireland, Ltd. Cost-effectiveness analysis of the New South Wales adult drug court program. Shanahan M; Lancsar E; Haas M; Lind B; Weatherburn D; Chen SL. Evaluation Review 28(1): 3-27, 2004. (19 refs.) In New South Wales, Australia, a cost-effectiveness evaluation was conducted of an adult drug court (ADC) program as an alternative to jail for criminal offenders addicted to illicit drugs. This article describes the program, the cost-effectiveness analysis, and the results. The results of this study reveal that, for the 23-month period of the evaluation, the ADC was as cost-effective as were conventional sanctions in delaying the time to the first offense and more cost-effective in reducing the frequency of offending for those outcome measures selected. Although the evaluation was conducted using the traditional steps of a cost-effectiveness analysis, because of the complexity of the program and data limitations it was not always possible to adhere to textbook procedures. As such, each step involved in undertaking the cost-effectiveness analysis is discussed, highlighting the key issues faced in the evaluation. Copyright 2004, Sage Publications, Inc. Implementation of evidence-based tobacco use cessation guidelines in managed care organizations. Taylor CB; Curry SJ. Annals of Behavioral Medicine 27(1): 13-21, 2004. (39 refs.) Background: Although managed care organizations (MCOs) may be optimal settings for implementing tobacco use cessation clinical guidelines, such guidelines remain poorly implemented in many MCO settings. Purpose: We examined issues related to the implementation of guidelines in MCOs, to provide examples of studies that have addressed issues related to guideline implementation and to suggest ways behavioral medicine researchers can play a role in examining issues of how guidelines can be better implemented. Methods: Surveys of clinical guideline implementation, studies from the Robert Wood Johnson Foundation addressing tobacco use cessation in a managed care database, selected to illustrate issues related to system-wide implementation. Results: Surveys show that effective tobacco use cessation interventions remain underutilized in MCOs. A few studies have evaluated and shown the benefit of insurance coverage for tobacco use and dependence treatments, clinician reimbursement and leadership incentives, practice feedback, and leveraging administrative data to create tobacco use tracking systems. The studies also point to the need for large-scale, multidisciplinary, methodologically rigorous studies that allow one to isolate the effects of promising strategies as well as to explore synergistic effects as different system changes are combined. Conclusions: Tobacco use cessation guidelines need to be better implemented in MCOs. Behavioral medicine research needs to move beyond treatment efficacy and effectiveness studies to focus on rigorous evaluations of these and other strategies to enhance guideline implementation and dissemination. Copyright 2004, Lawrence Erlbaum Associates, Inc. Processes and outcomes of substance abuse treatment within managed care: A preliminary report. McNeese-Smith DK; Crook MW; Marinelli-Casey P; Rawson R. Journal of Addictions Nursing 14(2): 65-73, 2003. (41 refs.) While managed care is changing substance abuse treatment (SAT), little is known about the relationship between managed care structures and SAT processes and outcomes. The purposes of this study are to describe: (1) client characteristics, (2) SAT processes provided by outpatient treatment under managed care, and (3) client outcomes in an insured and primarily employed population. Twenty SAT clients including equal numbers of males and females, in two Los Angeles settings were interviewed at three points before and after treatment. Instruments with established reliability and validity in SAT research, including the TCU Drug History Form and the Treatment Outcome Profile, were administered. Descriptive statistics were used to describe SAT clients, as well as processes and outcomes of treatment. Drug use