You can’t put a dollar value on the losses American families have suffered due to the addiction and overdose crisis. A life lost to overdose is irreplaceable, and the costs to happiness, success, and well-being of those living with addiction are similarly overwhelming and incalculable. Yet, funds are finite, and public health decisions do carry cost implications. When policymakers and community leaders can translate the human benefits of effective treatment and prevention measures into some quantifiable return on that investment, it can be a lever to shift public health policies.
Recently in the journal Prevention Science, a group of researchers funded by the National Institute on Drug Abuse (NIDA) published an analysis of the costs to North Carolina healthcare payers for hospital charges potentially relating to higher-risk behaviors in patients aged 9-18 (i.e., pre-adolescents and adolescents) in 2012. Charges included care for injuries from violence, accidents, or poisoning; care relating to sexual activity, substance use, or psychiatric disorders; and charges related to suicide or self-inflicted injury.
The researchers found that these charges totaled more than $327 million, accounting for more than 10 percent of all hospital-related charges. The higher-risk behaviors associated with these costs are preventable with psychosocial interventions, including family-based prevention programs. Pediatricians and family therapists surveyed in the study supported screening and referral to prevention, but cited possible challenges to reimbursement for these services as well as lack of training and lack of referral networks to/from each other. Pediatricians also cited concerns over patients not following through with referrals, suggesting that having family therapists working in pediatric clinics could help.
Primary prevention—including screening and intervention before negative health outcomes occur—is relatively inexpensive, and the higher-risk behaviors it is designed to reduce are so costly to the healthcare system that it is staggeringly wasteful not to make sure that screening and treatment referral are readily implemented and faithfully reimbursed by insurers and that interventions are convenient for parents and their children.
Reducing higher-risk behaviors would lessen burden across many sectors of society, not just healthcare, which was the sole focus of the newly published analysis. Greater investment in preventing such behaviors in youth would yield savings across public safety and the criminal justice system, behavioral health, education, and so on.
This is a common theme in the research on the benefits and costs of prevention. Some programs designed to prevent teen substance use and other behavioral problems have been found or estimated to be stunningly good investments. For example, an early childhood intervention called Nurse Family Partnership, in which specially trained nurses periodically visit first-time mothers during their pregnancy and first two years of their child’s life, was shown in an analysis by the Washington State Institute for Public Policy to save taxpayers $2.88 for each dollar invested; the same analysis found that a component of an elementary-school-based intervention called the Good Behavior Game saved taxpayers $25.92 for each dollar.
Another example is the Communities That Care prevention system, developed three decades ago and the subject of many randomized trials that follow participants well into adulthood. Communities That Care is not a single prevention intervention but a structured approach that helps communities utilize their resources most effectively to address identified risk factors for substance use, aggression, and other problems in youth. One recent analysis showed that an approximately $602 investment in each child (adjusted to 2017 dollars) had yielded an estimated $7754 in savings by the time participants were age 23—a $12.88 return for each dollar invested. The researchers estimated that those savings were distributed among individuals/families themselves, taxpayers, and other stakeholders. The return was well over twice as great when the downstream economic benefits of completing college—more likely among those receiving interventions—was factored in.
Prevention is needed now more than ever. Fentanyl is permeating the illicit drug supply and causing ever-greater numbers of overdose deaths. It is increasingly found in counterfeit prescription pills, which are liable to be taken by youth and other people with no previous exposure to opioids. In 2020, for the first time, fentanyl overdose deaths in teens spiked to nearly double the rate it had been in previous years.
Communities, schools, and healthcare systems already have scientifically well-supported tools at their disposal to help prevent substance use and other related mental illnesses and risk behaviors in adolescence, but sadly they are seldom implemented. Even if an intervention can be shown in a trial to produce benefits, it cannot be expected to make a positive impact if it is not easily scaled up in a variety of real-world settings adaptable to the needs of different communities. For this reason, developing and testing interventions that can be adopted and sustained is an important part of NIDA’s prevention research portfolio.
While investment in prevention doesn’t show immediate returns, playing the long game and investing in prevention interventions can save lives and dollars.