Washington State Institute for Public Policy
12-Step Facilitation Therapy
Substance Abuse: Substance Abuse Treatment for Adults
Benefit-cost estimates updated December 2016.  Literature review updated May 2014.
12-Step Facilitation Therapy is a stand-alone program that encourages patients' active participation in 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous. The intervention involves a brief, structured, and manual-driven approach, typically delivered in 12 to 15 weekly individual sessions.
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 $490 Benefits minus costs $5,016
Participants $752 Benefit to cost ratio n/a
Others $155 Chance the program will produce
Indirect $3,300 benefits greater than the costs 60 %
Total benefits $4,697
Net program cost $320
Benefits minus cost $5,016
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 $2 $0 $3
Property loss associated with alcohol abuse or dependence $0 $4 $8 $0 $12
Labor market earnings associated with illicit drug abuse or dependence $327 $720 $0 $3,062 $4,109
Health care associated with illicit drug abuse or dependence $162 $28 $145 $78 $414
Adjustment for deadweight cost of program $0 $0 $0 $160 $160
Totals $490 $752 $155 $3,300 $4,697
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $407 1993 Present value of net program costs (in 2015 dollars) $320
Comparison costs $924 2014 Cost range (+ or -) 10 %
12-Step Facilitation Therapy typically takes place over a three- to four-month period. Our per-participant costs are based on Cisler, R., Holder, H.D., Longabaugh, R., Stout, R.L., & Zweben, A., et al., (1998). Actual and estimated replication costs for alcohol treatment modalities: Case study from Project MATCH. Journal of Studies on Alcohol, 59(5), 503-12. Comparison groups in the largest studies received 12 individual hour-long sessions. We estimated the cost of this with Washington’s Medicaid reimbursement rate for substance abuse 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 6 627 -0.331 0.132 39 0.000 0.189 42 -0.317 0.016
Illicit drug abuse or dependence 5 545 -0.360 0.118 39 0.000 0.189 42 -0.374 0.002
Citations Used in the Meta-Analysis

Carroll, K., Nich, C., Ball, S., Mccance, E., & Rounsavile, B. (1998). Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction, 93(5), 713-727.

Carroll, K.M., Nich, C., Shi, J.M., Eagan, D., Ball, S.A. (2012) Efficacy of disulfiram and Twelve Step Facilitation in cocaine-dependent individuals maintained on methadone: A randomized placebo-controlled trial. Drug and Alcohol Dependence, 126, 224-231.

Donovan, D.M., Daley, D.C., Brigham, G.S., Hodgkins, C.C., Perl, H. I., Garrett, S.B., Doyle, S.R., . . . Zammarelli, L. (2013). Stimulant abuser groups to engage in 12-Step: A multisite trial in the National Institute on Drug Abuse Clinical Trials Network. Journal of Substance Abuse Treatment, 44(1), 103-114

Kahler, C.W., Read, J.P., Ramsey, S.E., Stuart, G. L., McCrady, B.S., & Brown, R.A. (2004). Motivational enhancement for 12-step involvement among patients undergoing alcohol detoxification. Journal of Consulting and Clinical Psychology, 72(4), 736-741.

Kaskutas, L.A., Subbaraman, M., Witbrodt, J., Zemore, S.E. (2009) Effectiveness of Making Alcoholics Anonymous Easier (MAAEZ), a group format 12-step facilitation program. Journal of Substance Abuse Treatment, 37(3), 228-239.

Timko, C., DeBenedetti, A., & Billow, R. (2006). Intensive referral to 12-Step self-help groups and 6-month substance use disorder outcomes. Addiction, 101(5), 678-688.

Walitzer, K.S., Dermen, K H., & Barrick, C. (2009). Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial. Addiction, 104(3), 391-401.

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