|Benefit-Cost Summary Statistics Per Participant|
|Taxpayers||$2,727||Benefits minus costs||$7,139|
|Participants||$1,626||Benefit to cost ratio||$25.85|
|Others||$2,120||Chance the program will produce|
|Indirect||$953||benefits greater than the costs||53 %|
|Net program cost||($287)|
|Benefits minus cost||$7,139|
|Meta-Analysis of Program Effects|
|Outcomes measured||Treatment age||No. of effect sizes||Treatment N||Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis||Unadjusted effect size (random effects model)|
|First time ES is estimated||Second time ES is estimated|
Adult use of cannabis that does not rise to the level of “disordered.”
Drinking and driving^
Official or self-reported drinking and driving—arrests, citations, or behavior.
Emergency department visits
Whether someone visited the emergency department, or the number of times they visited the emergency department.
Hospital admission, for any reason.
Illicit drug use^
Adult use of illicit drugs that does not rise to the level of “disordered.” When possible, we exclude cannabis/marijuana use from this outcome.
Opioid drug use^
Adult use of opioids that does not rise to the level of “disordered.”
Problem alcohol use
Alcohol use reflecting problem behaviors (e.g., high frequency drinking, binge drinking, or drinking that has a high impact on daily life) for individuals who do not have an alcohol use disorder.
|Detailed Monetary Benefit Estimates Per Participant|
|Affected outcome:||Resulting benefits:1||Benefits accrue to:|
|Problem alcohol use||Criminal justice system||$0||$0||$2||$0||$2|
|Labor market earnings associated with problem alcohol use||$639||$1,502||$0||$0||$2,142|
|Property loss associated with problem alcohol use||$0||$4||$7||$0||$11|
|Mortality associated with problem alcohol||$2||$4||$0||$54||$60|
|Hospitalization||Health care associated with general hospitalization||$1,975||$85||$1,947||$987||$4,994|
|Emergency department visits||Health care associated with emergency department visits||$111||$30||$164||$56||$361|
|Program cost||Adjustment for deadweight cost of program||$0||$0||$0||($144)||($144)|
|Detailed Annual Cost Estimates Per Participant|
|Annual cost||Year dollars||Summary|
|Program costs||$205||2000||Present value of net program costs (in 2018 dollars)||($287)|
|Comparison costs||$0||2000||Cost range (+ or -)||20 %|
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
|Benefits Minus Costs Over Time (Cumulative Discounted Dollars)|
|The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.|
Aalto, M., Saksanen, R., Laine, P., Forsstrom, R., Raikaa, M., Kiviluoto, M., et al. (2000) Brief intervention for female heavy drinkers in routine general practice: A 3-year randomized controlled study. Alcoholism: Clinical and Experimental Research, 24(11), 1680-1686.
Aalto, M., Seppa, K., Mattila, P., Mustonen, H., Ruuth, K., , . . . Sillanaukee, P. (2001). Brief intervention for male heavy drinkers in routine general practice: a three-year randomized controlled study. Alcohol and Alcoholism, 36(3), 224-230.
Anderson, P. & Scott, E. (1992). The effect of general practitioners' advice to heavy drinking men. British Journal of Addiction, 87, 891-900.
Assanangkornchai, S., McNeil, E.B., Edwards, J.G., Nima, P., & Edwards, J.G. (2015). Comparative trial of the WHO ASSIST-linked brief intervention and simple advice for substance abuse in primary care. Asian Journal of Psychiatry, 18, 75-80.
Babor, T. F., & Grant, M. (1992). Project on identification and management of alcohol-related problems: Report on Phase II: A randomized clinical trial of brief interventions in primary health care. Geneva, Switzerland: World Health Organization.
Babor, T.F., Higgins-Biddle, J.C., Dauser, D., Burleson, J.A., Zarkin, G.A., & Bray, J. (2006). Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations. Alcohol and Alcoholism (oxford, Oxfordshire), 41, 6.
Bernstein, J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77(1), 49-59.
Chang, G., McNamara, T. K., Orav, E. J., Koby, D., Lavigne, A., Ludman, B., Vincitorio, N. A., . . . Wilkins-Haug, L. (2005). Brief intervention for prenatal alcohol use: a randomized trial. Obstetrics and Gynecology, 105(5), 991-8.
Chang, G., Fisher, N.D.L., Hornstein, M.D., Jones, J.A., Hauke, S.H., Niamkey, N., Briegleb, C., . . . Orav, E.J. (2011). Brief intervention for women with risky drinking and medical diagnoses: A randomized controlled trial. Journal of Substance Abuse Treatment, 41(2), 105-114.
Crawford, M.J., Sanatinia, R., Barrett, B., Byford, S., Dean, M., Green, J., Jones, R., . . . Ward, H. (2014). The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR). Health Technology Assessment, 18(30), 1-48.
Curry, S.J., Ludman, E.J., Grothaus, L.C., Donovan, D., & Kim, E. (2003). A randomized trial of a brief primary-care-based intervention for reducing at-risk drinking practices. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 22(2), 156-65.
Emmen, M.J., Schippers, G.M., Wollersheim, H., & Bleijenberg, G. (2005). Adding psychologist's intervention to physicians' advice to problem drinkers in the outpatient clinic. Alcohol and Alcoholism, 40(3), 219-226.
Fleming, M.F., Manwell, L.B., Barry, K.L., Adams, W. & Stauffacher, E.A. (1999). Brief physician advice for alcohol problems in older adults: A randomized community-based trial. Journal of Family Practice, 48, 378-384.
Fleming, M.F., Barry, K.L., Manwell, L.B., Johnson, K. & London, R. (1997). Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices. Journal of the American Medical Association, 277, 1039-1045.
Fleming, M.F., Mundt, M.P., French, M.T., Manwell, L.B., Stauffacher, E.A. & Barry, K.L. (2002). Brief physician advice for problem drinkers: Long-term efficacy and benefit-cost analysis. Alcoholism: Clinical and Experimental Research, 26(1), 36-43.
Fleming, M., Brown, R., & Brown, D. (2004). The efficacy of a brief alcohol intervention combined with CDT feedback in patients being treated for type 2 diabetes and/or hypertension. Journal of Studies on Alcohol, 65(5), 631-7.
Fleming, M.F., Lund, M.R., Wilton, G., Landry, M., & Scheets, D. (2008). The healthy moms study: The efficacy of brief alcohol intervention in postpartum women. Alcoholism, Clinical and Experimental Research, 32(9), 1600-6.
Fleming, M. F., Balousek, S. L., Grossberg, P. M., Mundt, M. P., Brown, D., Wiegel, J. R., Zakletskaia, L. I., . . . Saewyc, E. M. (2010). Brief physician advice for heavy drinking college students: a randomized controlled trial in college health clinics. Journal of Studies on Alcohol and Drugs, 71(1), 23-31.
Freeborn, D. K., Polen, M. R., Hollis, J. F., & Senft, R. A. (2000). Screening and brief intervention for hazardous drinking in an HMO: effects on medical care utilization. The Journal of Behavioral Health Services & Research, 27(4), 446-53.
Gelberg, L., Andersen, R. M., Afifi, A.A., Leake, B.D., Arangua, L., Vahidi, M., Singleton, K., . . . Baumeister, S.E. (2015). Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care-based multi-component brief intervention to reduce risky drug use. Addiction, 110(11), 1777-1790.
Grossberg, P.M., Brown, D.D. & Fleming, M.F. (2004). Brief Physician Advice for High-Risk Drinking Among Young Adults. Annals of Family Medicine, 2(5), 474-480.
Heather, N., Campion, P.D., Neville, R.G., & Maccabe, D. (1987). Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (The DRAMS scheme). Journal of the Royal College of General Practitioners, 37(301), 358-363.
Humeniuk, R., Ali, R., Babor, T., Souza-Formigoni, M.L.O., de, L.R.B., Ling, W., McRee, B., . . . Vendetti, J. (2012). A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction, 107(5), 957-966.
Israel, Y., Hollander, O., Sanchez-Craig, M., Booker, S., Miller, V., Gingrich, R., & Rankin, J. G. (1996). Screening for problem drinking and counseling by the primary care physician-nurse team. Alcoholism, Clinical and Experimental Research, 20(8), 1443-50.
Kaner, E., Newbury-Birch, D., Bland, M., Coulton, S., Godfrey, C., Parrott, S., Cassidy, P., . . . Shepherd, J. (2013). Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): Pragmatic cluster randomised controlled trial. Bmj, 346, 7892.
Kristenson, H., Ohlin, H., Hulten-Nosslin, M.B., Trell, E., & Hood, B. (1983). Identification and intervention of heavy drinking in middle-aged men: Results and follow-up of 24-60 months of long-term study with randomized controls. Alcoholism: Clinical and Experimental Research, 7, 203-209.
Kypri, K., Saunders, J.B., Williams, S.M., McGee, R.O., Langley, J.D., Cashell-Smith, M.L., & Gallagher, S.J. (2004). Web-based screening and brief intervention for hazardous drinking: A double-blind randomized controlled trial. Addiction, 99, 11.
Kypri, K., Langley, J. D., Saunders, J. B., Cashell-Smith, M. L., & Herbison, P. (2008). Randomized controlled trial of web-based alcohol screening and brief intervention in primary care. Archives of Internal Medicine, 168(5), 530-536.
Lock, C. A., Kaner, E., Heather, N., Doughty, J., Crawshaw, A., McNamee, P., Purdy, S., . . . Pearson, P. (2006). Effectiveness of nurse-led brief alcohol intervention: a cluster randomized controlled trial. Journal of Advanced Nursing, 54(4), 426-439.
Maheswaran, R., Beevers, M., & Beevers, D.G. (1992). Effectiveness of advice to reduce alcohol consumption in hypertensive patients. Hypertension, 19, 79-84.
Maisto, S.A., Conigliaro, J., McNeil, M., Kraemer, K., Conigliaro, R. L., & Kelley, M. E. (2001). Effects of two types of brief intervention and readiness to change on alcohol use in hazardous drinkers. Journal of Studies on Alcohol, 62(5), 605-614.
Manwell, L.B., Fleming, M.F., Mundt, M.P., Staffacher, E.A., & Barry, K.L., (2000). Treatment of problem alcohol use in women of childbearing age: Results of a brief intervention trial. Alcoholism: Clinical and Experimental Research, 24(10), 1517-1524.
Mertens, J.R., Ward, C.L., Bresick, G.F., Broder, T., & Weisner, C.M. (2014). Effectiveness of nurse-practitioner-delivered brief motivational intervention for young adult alcohol and drug use in primary care in South Africa: A randomized clinical trial. Alcohol and Alcoholism, 49(4), 430-438.
Nilssen, O. (1991). The Tromso Study: Identification of and a controlled intervention on a population of early-stage risk drinkers. Preventive Medicine,20, 518-528.
Noknoy, S., Rangsin, R., Saengcharnchai, P., Tantibhaedhyangkul, U., & McCambridge, J. (2010). RCT of effectiveness of motivational enhancement therapy delivered by nurses for hazardous drinkers in primary care units in Thailand. Alcohol and Alcoholism, 45(3), 263-270.
Ockene, J.K., Adams, A., Hurley, T., Wheeler, E. & Hebert, J.R. (1999). Brief physician- and nurse practitioner-delivered counseling for high-risk drinkers: Does it work? Archives of Internal Medicine, 159(18), 2198-2205.
Richmond, R., Heather, N. Wodak, A. Kehoe, L., & Webster, I. (1995). Controlled evaluation of a general practice-based brief intervention for excessive drinking. Addiction 90(1), 119-132.
Romelsjö, A., Andersson, L, Barrner, H., Borg, S., Granstrand, C., Hultman, O., . . . Wikblad, O. (1989). A randomized study of secondary prevention of early stage problem drinkers in primary health care. British Journal of Addiction, 84(11), 1319-1327.
Roy-Byrne, P., Bumgardner, K., Krupski, A., Dunn, C., Ries, R., Donovan, D., West, I. I., . . . Zarkin, G.A. (2014). Brief intervention for problem drug use in safety-net primary care settings. Jama, 312(5), 492.
Saitz, R., Palfai, T.P., Cheng, D., Alford, D.P., Bernstein, J.A., Lloyd, T.C.A., Meli, S.M., . . . Samet, J.H. (2014). Screening and brief intervention for drug use in primary care: The ASPIRE randomized trial. Drug and Alcohol Dependence, 140.
Schaus, J. F., Sole, M. L., McCoy, T. P., Mullett, N., & O'Brien, M. C. (2009). Alcohol screening and brief intervention in a college student health center: A randomized controlled trial. Journal of Studies on Alcohol and Drugs, Suppl. 16, 131-141.
Scott, E. & Anderson, P. (1990). Randomized controlled trial of general practitioner intervention in women with excessive alcohol consumption. Drug and Alcohol Review, 10(4), 313-321.
Senft, R.A., Polen, M.R., Freeborn, D.K. & Hollis, J.F. (1997). Brief intervention in a primary care setting for hazardous drinkers. American Journal of Preventive Medicine, 13(6), 464-470.
Wallace, P., Cutler, S., & Haines , A. (1988). Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. British Medical Journal, 297(6649), 663-668.