Washington State Institute for Public Policy
Holistic Harm Reduction Program (HHRP+)
Substance Abuse: Substance Abuse Treatment for Adults
Benefit-cost estimates updated December 2016.  Literature review updated May 2014.
The Holistic Harm Reduction Program (HHRP+), also called Holistic Health Recovery Program, is a manualized treatment for those with drug abuse or dependence who are HIV positive. The primary goals of HHRP+ are harm reduction, health promotion, and improving quality of life. These goals are achieved by providing the knowledge, motivation, and skills necessary to make choices that reduce harm to oneself and others. HHRP+ also addresses medical, emotional, social, and spiritual problems that can impede harm reduction. The treatment is generally provided in 12 group sessions over three to six months. In the reviewed studies, HHRP+ was provided in addition to methadone treatment and standard counseling.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2015). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $448 Benefits minus costs $2,951
Participants $681 Benefit to cost ratio $4.68
Others $135 Chance the program will produce
Indirect $2,491 benefits greater than the costs 56 %
Total benefits $3,754
Net program cost ($803)
Benefits minus cost $2,951
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Crime $0 $0 $1 $0 $1
Labor market earnings associated with illicit drug abuse or dependence $297 $655 $0 $2,816 $3,768
Health care associated with illicit drug abuse or dependence $150 $26 $135 $75 $386
Adjustment for deadweight cost of program $0 $0 $0 ($401) ($401)
Totals $448 $681 $135 $2,491 $3,754
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $789 2013 Present value of net program costs (in 2015 dollars) ($803)
Comparison costs $0 2013 Cost range (+ or -) 25 %
This program is typically administered over a three- to six-month period. The per-participant cost of treatment is the weighted average estimate of the additional group therapy sessions provided in the studies included in the analysis. We calculated this average estimate using Washington's Medicaid hourly reimbursement rate for outpatient group therapy multiplied by the weighted average of total hours of outpatient group therapy across the studies (averaging 40 total hours). The costs of the intervention are in addition to the costs of methadone treatment and standard counseling provided to both the treated and comparison groups in the reviewed studies.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-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 non-discounted dollars to simplify the “break-even” point from a budgeting perspective. 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.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant 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
ES SE Age ES SE Age ES p-value
Illicit drug abuse or dependence 2 153 -0.311 0.144 39 0.000 0.187 42 -0.311 0.031
STD risky behavior 2 153 -0.260 0.134 39 0.000 0.000 40 -0.260 0.053
Citations Used in the Meta-Analysis

Avants, S.K., Margolin, A., Usubiaga, M.H. & Doebrick, C. (2004). Targeting HIV-Related Outcomes With Intravenous Drug Users Maintained on Methadone: A Randomized Clinical Trial of a Harm Reduction Group Therapy. Journal of Substance Abuse Treatment, 26(2), 67-78.

Margolin, A., Avants, S.K., Warburton, L.A., Hawkins, K.A. & Shi, J. (2003). A Randomized Clinical Trial of a Manual-Guided Risk Reduction Intervention for HIV-Positive Injection Drug Users. Health Psychology, 22(2), 223-228.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov