Outcomes of a Court-Based Substance Use Disorder Diversion Pilot Program: A Cost Analysis

Abstract

This research presents the outcomes of a substance use diversion program in a Midwestern county. Specifically, this work assesses the efficacy (operationalized through re-arrest) and cost-efficacy (operationalized through cost per 1% reduction in re-arrest likelihood) of the program across varying levels of American Society of Addiction Medicine levels of care (ASAM LOC). Using a sample of 430 program participants, findings illustrate that the program overall reduced the likelihood of re-arrest over both a 6- and 12-month horizon across program completers. However, more granular analyses revealed differences across ASAM LOC; the most statistically robust form of treatment was the most intensive 3.5 ASAM LOC, which led to an 82% reduction in 6-month re-arrest and an 80% reduction in 12-month re-arrest for those who completed the program relative to those who did not. The 3.5 ASAM LOC was also the most cost-effective among those explored, costing $66.04 per 1% reduction in recidivism. The outcomes of this work emphasize (a) the relevance of the ASAM LOC in determining program efficacy and (b) the need for varying levels of treatment intensity to better accommodate the needs of substance use disorder diversion participants.

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“…Benefit-cost analysis, cost-utility analysis, and cost-effectiveness studies are three different approaches often employed to understand the benefits gained, the preferences honored, and/or the effectiveness of a specific program. To contribute to the broader understanding of the efficacy and cost-efficacy of such programs, we examined 39 months of data from a Midwestern drug diversion program that treated individuals diagnosed with Substance Use Disorder (SUD) according to a Level Of Care (LOC) that was assigned to them through the Addiction Society and Medicine (ASAM) criteria [9]. We employed a cost-effectiveness approach, specifically seeking to understand the cost required to gain a 1% reduction in the likelihood of re-arrest across three treatment settings: the most intensive setting (3.5 ASAM LOC), a moderate intensity setting (3.1 ASAM LOC), and the least intensive (therapeutic care, or TC).…”