Washington State Institute for Public Policy
Behavioral self-control training (BSCT)
Substance Abuse: Substance Abuse Treatment for Adults
Benefit-cost estimates updated December 2016.  Literature review updated May 2014.
Behavioral self-control training is a standalone treatment approach often used to pursue a goal of moderate or non-problematic drinking rather than complete abstinence, although abstinence goals are also permissible. This approach teaches self-monitoring, managing drinking speed and duration, identifying high-risk situations, goal setting, rewards for goal attainment, and coping skills. When used with a goal of moderate or controlled drinking, behavioral self-control training is contra-indicated for pregnant women, women trying to become pregnant, clients with medical or psychological problems worsened by drinking, clients who are mandated to remain abstinent, or in other situations where there is strong pressure for abstinence. Treatment in the included studies occurred over one to three months.
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 ($3,426) Benefits minus costs ($12,798)
Participants ($6,941) Benefit to cost ratio ($81.03)
Others ($313) Chance the program will produce
Indirect ($1,962) benefits greater than the costs 24 %
Total benefits ($12,642)
Net program cost ($156)
Benefits minus cost ($12,798)
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 ($1) $0 ($3) ($1) ($6)
Labor market earnings associated with alcohol abuse or dependence ($3,122) ($6,875) $0 ($1,731) ($11,729)
Health care associated with alcohol abuse or dependence ($302) ($54) ($288) ($152) ($796)
Property loss associated with alcohol abuse or dependence $0 ($12) ($22) $0 ($34)
Adjustment for deadweight cost of program $0 $0 $0 ($78) ($78)
Totals ($3,426) ($6,941) ($313) ($1,962) ($12,642)
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $957 2013 Present value of net program costs (in 2015 dollars) ($156)
Comparison costs $804 2013 Cost range (+ or -) 10 %
In the studies included in our meta-analysis, treatment took place over a one- to three-month period. The per-participant cost of treatment is the weighted average estimate for studies included in the analysis. We calculated this average estimate using Washington's Medicaid hourly reimbursement rates for individual or group therapy multiplied by the weighted average of total hours of these therapies across the studies (averaging 12 total hours). Comparison group costs are computed in a similar manner based on treatment received in the studies (individual or group treatment as usual or no treatment).
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
Alcohol abuse or dependence 12 333 -0.393 0.161 41 0.165 0.181 42 -0.393 0.001
Drinking and driving 1 20 -1.048 0.337 41 0.000 0.000 42 -1.048 0.001
Citations Used in the Meta-Analysis

Alden, L. (1988). Behavioral self-management controlled-drinking strategies in a context of secondary prevention. Journal of Consulting and Clinical Psychology, 56(2), 280-286.

Baker, T.B., Udin, H., Vogler, R. The Effects of Videotaped Modeling and Self-Confrontation on the Drinking Behavior of Alcoholics. The International Journal of the Addictions, 10(5), 779-793.

Brown, R.A. (1980). Conventional education and controlled drinking education courses with convicted drunken drivers. Behavior Therapy, 11(5), 632-642.

Caddy, G.R. & Lovibond, S.H. (1976). Self-regulation and discriminated aversive conditioning in the modification of alcoholics drinking behavior. Behavior Therapy, 7(2), 223-230.

Foy, D.W., Nunn, B.L., & Rychtarik, R.G. (1984). Broad-spectrum behavioral treatment for chronic alcoholics: Effects of training controlled drinking skills. Journal of Consulting and Clinical Psychology, 52(2), 218-230.

Graber, R.A., Miller, W.R. (1988). Abstinence or Controlled Drinking Goals for Problem Drinkers: A Randomized Clinical Trial. Psychology of Addictive Behaviors, 2(1), 20-33.

Harris, K.B. and W.R. Miller. (1990). Behavioral Self-Control Training for Problem Drinkers: Components of Efficacy. Psychology of Addictive Behaviors 4(2), 82-90.

Heather, N., Whitton, B., & Robertson, I. (1986). Evaluation of a self-help manual for media-recruited problem drinkers: Six-month follow-up results. The British Journal of Clinical Psychology, 25, 19-34.

Hester, R.K. & Delaney, H.D. (1997). Behavioral self-control program for windows: Results of a controlled clinical trial. Journal of Consulting and Clinical Psychology, 65(4), 686-693.

Sanchez-Craig, M. (1980). Random assignment to abstinence or controlled drinking in a cognitive-behavioral program: Short-term effects on drinking behavior. Addictive Behaviors, 5(1), 35-39.

Sanchez-Craig, M., Annis, H.M., Bornet, A.R., & MacDonald, K.R. (1984). Random assignment to abstinence and controlled drinking: Evaluation of a cognitive-behavioral program for problem drinkers. Journal of Consulting and Clinical Psychology, 52(3), 390-403.

Vogler, R.E., Compton, J.V., & Weissbach, T.A. (1975). Integrated behavior change techniques for alcoholics. Journal of Consulting and Clinical Psychology, 43(2), 233-243.

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