Adult and Youth Substance Use Benefit-Cost Analysis

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Table of contents

Table of contents ........................................................................................................................................................3

Table of Figures ..........................................................................................................................................................4

Acknowledgments ......................................................................................................................................................6

Results First Advisory Committee ..........................................................................................................................6

Report Authors .......................................................................................................................................................6

Results First Substance Use Analysis - Executive summary .......................................................................................7

Minnesota Results First ..............................................................................................................................................9

Background ............................................................................................................................................................9

Results First framework .........................................................................................................................................9

Background .............................................................................................................................................................. 11

The continuum of care for substance use disorders........................................................................................... 11

Disordered use in Minnesota .............................................................................................................................. 14

Substance use disorder system governance and funding................................................................................... 18

Evidence-based principles, practices, and protocols for substance use disorder .............................................. 22

Culturally-specific practices ................................................................................................................................ 23

Findings.................................................................................................................................................................... 25

Overview ............................................................................................................................................................. 25

Prevention Services ............................................................................................................................................. 28

Treatment and Recovery Services....................................................................................................................... 34

Key considerations .................................................................................................................................................. 44

Using evidence-based services............................................................................................................................ 44

Targeting promotion, prevention, and early intervention.................................................................................. 51

Service availability, .............................................................................................................................................. 56

The importance of implementation .................................................................................................................... 60

Data availability and billing discussions .............................................................................................................. 64

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Conclusion ............................................................................................................................................................... 66

Appendix A: Inventory of services ........................................................................................................................... 67

Appendix B: Summary of research methods ........................................................................................................... 86

Inventory of services ........................................................................................................................................... 86

Benefit-cost analysis ........................................................................................................................................... 86

Data quality and limitations ................................................................................................................................ 87

Apportioning benefits and costs ......................................................................................................................... 88

Appendix C: Breakeven analysis .............................................................................................................................. 90

Appendix D: Heroin and other opiate treatment admissions per 10,000 people and methadone maintenance

providers, by county, 2016 ...................................................................................................................................... 91

Table of Figures

Figure 1: Comparison of benefit-cost ratios for prevention and early intervention services ....................................8

Figure 2: Comparison of benefit-cost ratios for treatment and recovery services ....................................................8

Figure 3: Explanation of a benefit-cost ratio ........................................................................................................... 10

Figure 4: Continuum of Care ................................................................................................................................... 12

Figure 5: Substance use in Minnesota and the United States, by age group: percentages, annual averages based

on 2013-2014 .......................................................................................................................................................... 15

Figure 6: Illegal drug use, past month among persons aged 12 or older, by demographic characteristic,

nationwide, 2014 ..................................................................................................................................................... 15

Figure 7: Cigarette use in past month among persons aged 12 or older, by race/ethnicity, nationwide, 2014 .... 16

Figure 8: Overdose deaths by drug category, MN residents, statewide 2000-2015............................................... 17

Figure 9: Proportion of treatment admissions paid by various sources, 2011-2016 .............................................. 22

Figure 10: Benefit-cost analysis terms .................................................................................................................... 26

Figure 11: Categories of policy levers...................................................................................................................... 46

Figure 12: Results First review of pharmacotherapies for alcohol, opioids, and other drugs ................................ 49

Figure 13: Lifetime value to Minnesotans for avoiding substance use disorder .................................................... 51

Figure 14: Examples of evidence-based policies and practices to reduce alcohol misuse ..................................... 53

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Figure 15: CDC rating on state beer excise tax level in Minnesota, 2014 ............................................................... 53

Figure 16: CDC rating on funding tobacco control in Minnesota, 2015 .................................................................. 54

Figure 17: Strategies for implementing SBIRT ......................................................................................................... 55

Figure 18: Substance use disorder treatment admissions in Minnesota, by setting, 2011 and 2016 .................... 58

Figure 19: Job Vacancies in Behavioral Health, Minnesota, 4th Quarter 2016 ....................................................... 59

Figure 20: Procedure codes for mental health ........................................................................................................ 64

Figure 21: Substance use disorder treatment rate grid, January 2017 ................................................................... 64

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