ALCOHOL, COCAINE, MARIJUANA, OPIOID, HERION, HALLUCINOGENS, AMPHETAMINE ABUSE TREATMENT AND PREVENTION OF OTHER RISKY BEHAVIORS
Addiction has become a national crisis of morbidity, mortality, and economic and societal well-being in the United States and around the world, creating an enormous emotional and financial burden on individuals, families and society. Thus, it is imperative to determine cost-effective interventions to more efficiently use our limited health care resources. In our studies, we have conducted economic evaluations to identify, measure, and compare the costs of substance abuse interventions in various contexts.
SUBSTANCE ABUSE INTERVENTIONS
National Institute on Drug Abuse Cooperative Agreement Standard Intervention (SI)
SI + Well Woman Exam (WWE)
SI + WWE + Four Educational Sessions (4ES)
Are peer-delivered interventions for cocaine and alcohol abuse among women cost-effective?
Our research suggests that peer-delivered interventions can be a cost-effective way to address the needs of women abusing cocaine and alcohol, a growing and underserved population.
What is the most cost-effective intervention to prevent HIV /AIDS and STDs among women?
We found that well woman exams are the most cost-effective behavioral intervention compared to NIDA standard intervention in hepatitis C infections, gonorrhea, and HIV.
cost-effective treatments for heroin dependence
IS BUPRENORPHINE OR NALTREXONE MORE COST-EFFECTIVE IN TREATING HEROIN DEPENDENCE?
Opiate addiction is a global problem afflicting an estimated 13-22 million people worldwide, more than half of whom live in Asia. Buprenorphine and naltrexone are two treatments used to treat opioid dependence. To aid public health policymaking, we studied the cost-effectiveness of three different interventions for heroin dependence in Malaysia. Our findings suggest that buprenorphine appears to be a cost-effective alternative to naltrexone that might enhance economic productivity and reduce drug use over a longer term.
METHODS
RESULTS
IMPLICATIONS
Our study, published in the PLOS ONE, examined the cost-effectiveness of buprenorphine, naltrexone, and placebo interventions for heroin dependence in Malaysia.
We found that buprenorphine to be a more cost-effective compared to naltrexone in Malaysia and can be used to treat heroin dependence in even poor countries at a cost that can be within reach, especially if drug discounts and foreign aid are made available for this purpose.
This analysis will help policymakers evaluate the economic feasibility and comparative desirability of different heroin treatment programs – crucial issues in developing countries with limited resources and significant HIV/AIDS and drug abuse problems.
DRUG ABUSE AND HIV PREVENTION PROGRAMS
Drug abuse and transmission of HIV during pregnancy are public health problems that adversely affect pregnant women, their children and surrounding communities. Programs to prevent HIV and drug abuse are cost-effective and save money for mother, child, and society. Economic evaluations of programs that address these issues are an important tool to better understand the costs of services and create sustainable healthcare systems.
We found that many programs for drug abuse treatment and prevention of mother-to-child transmission are cost-effective and even cost-saving, but economic evaluations across studies differed greatly in approach and evaluation methods.
SUBSTANCE USE IN PREGNANT WOMEN
Approximately 11% of reproductive age women use illicit substances, 25% use cigarettes, and 30% binge drink or use heavy amounts of alcohol. Pregnancy interrupts the pattern of substance use in many women. Nearly 50% of pregnant women who smoke cigarettes and 70-90% of women who use illicit substances achieve abstinence in pregnancy. However, women who have history of substance abuse may also be at higher risk for rapid repeat pregnancy. Thus, it is important to understand the risk of rapid repeat pregnancy among this group, given the range of adverse pregnancy and infant outcomes associated with prenatal substance exposure. Our lab has conducted studies to compare rates of abstinence and relapse of various substances and investigate patterns between substance use histories, rapid repeat pregnancy, and postpartum contraception.
HOW DOES PREGNANCY INTERVENTION IMPACT SUBSTANCE USE ABSTINENCE?
Our findings suggest differences in the risk of abstinence and relapse between substances used by perinatal women, and point to pregnancy and the postpartum period as opportunities for intervention that can lead to long-term abstinence. Interventions identifying the motivational factors that support positive behavior change and capitalize on the intrinsic and extrinsic factors that might be contributing to pregnancy-related discontinuation are necessary.
HOW DOES POSTPARTUM CONTRACEPTION INITIATION IMPACT THE NUMBER OF RAPID REPEAT PREGNANCY IN WOMEN WITH SUBSTANCE USE DISORDERS?
Initiation of contraception during the postpartum period can diminish rates of rapid repeat pregnancy, especially among vulnerable populations such as women who use substances. Greater update of LARC may reduce rates even further and allow for better pregnancy planning.
BEHAVIORAL INTERVENTION FOR SUBSTANCE USE TREATMENT IN PREGNANT WOMEN
Substance use in pregnancy is associated with severe maternal and fetal morbidities and substantial economic costs. Our study evaluated the economic impact of behavioral intervention that integrated motivational enhancement therapy with cognitive behavioral therapy (MET-CBT) for treatment of substance use in pregnancy, in comparison with brief advice.
We found that behavioral intervention integrating motivational enhancement therapy with cognitive behavioral therapy had similar effect on substance use and birth outcomes, and did not reduce overall medical costs up to 3-month postpartum.