Washington State Institute for Public Policy
Cognitive-behavioral coping-skills therapy for alcohol or drug use disorders
Substance Use Disorders: Treatment for Adults
Benefit-cost estimates updated May 2017.  Literature review updated September 2016.
Cognitive-behavioral coping-skills therapy is a manualized, standalone treatment for alcohol and/or drug abuse or dependence. This intervention emphasizes identifying high-risk situations that could lead to relapse such as social situations, depression, etc. and developing skills to cope with those situations. Clients engage in problem solving, role playing, and homework practice. The intervention is often provided in an individual therapy format but can be conducted in groups as well. Treatment in the included studies occurred over an average of 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 (2016). 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 $680 Benefits minus costs $5,572
Participants $968 Benefit to cost ratio $21.95
Others $271 Chance the program will produce
Indirect $3,918 benefits greater than the costs 60 %
Total benefits $5,837
Net program cost ($266)
Benefits minus cost $5,572
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 $4
Property loss associated with alcohol abuse or dependence $0 $4 $8 $0 $13
Labor market earnings associated with illicit drug abuse or dependence $414 $912 $0 $3,918 $5,243
Health care associated with illicit drug abuse or dependence $265 $52 $260 $132 $710
Adjustment for deadweight cost of program $0 $0 $0 ($132) ($132)
Totals $680 $968 $271 $3,918 $5,837
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $842 2013 Present value of net program costs (in 2016 dollars) ($266)
Comparison costs $584 2013 Cost range (+ or -) 10 %
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 and group outpatient therapy multiplied by the weighted average of total hours of outpatient individual and group therapy across the studies (averaging 18 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.

^^WSIPP does not include this outcome when conducting benefit-cost analysis for this program.

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 use disorder 7 190 -0.229 0.122 37 0.000 0.187 40 -0.229 0.060
Employment^^ 2 44 0.363 0.291 37 0.000 0.000 38 0.363 0.673
Illicit drug use disorder 6 312 -0.218 0.095 37 0.000 0.187 40 -0.218 0.021
Post-traumatic stress 1 34 -0.269 0.247 37 0.000 0.000 40 -0.269 0.276
Citations Used in the Meta-Analysis

Ball, S.A., Todd, M., Tennen, H., Armeli, S., Mohr, C., Affleck, G., & Kranzler, H.R. (2007). Brief motivational enhancement and coping skills interventions for heavy drinking. Addictive Behaviors, 32(6), 1105-1118.

Balldin, J., Berglund, M., Borg, S., Magnsson, M., Bendtsen, P., Franck, J., . . . Willander, A. (2003). A 6-month controlled naltrexone study: combined effect with cognitive behavioral therapy in outpatient treatment of alcohol dependence. Alcoholism, Clinical and Experimental Research, 27(7), 1142-1149.

Carroll, K.M., Rounsaville, B.J., Gordon, L.T., Nich, C., Jatlow, P.M. & Bisighini, R.M. (1994). Psychotherapy and Pharmacotherapy for Ambulatory Cocaine Abusers. Archives of General Psychiatry, 51(3), 177-187.

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.

Chaney, E.F., M.R. O'Leary, and A.G. Marlatt. (1978). Skill Training With Alcoholics. Journal of Consulting and Clinical Psychology, 46(5), 1092-1104.

Hawkins, J.D., Catalano, R.F., Gillmore, M.R. & Wells, E.A. (1989). Skills Training for Drug Abusers: Generalization, Maintenance, and Effects on Drug Use. Journal of Consulting and Clinical Psychology, 57(4), 559-563.

Hien, D.A., Cohen, L.R., Miele, G.M., Litt, L.C., Capstick, C. 2004. Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161(8), 1426-1432.

Kadden, R.M., Cooney, N.L., Getter, H., & Litt, M.D. (1989). Matching alcoholics to coping skills or interactional therapies: Posttreatment results. Journal of Consulting and Clinical Psychology, 57(6), 698-704.

Monti, P., Rohsenow, D., Michalec, E., Martin, R., & Abrams, D. (1997). Brief coping skills treatment for cocaine abuse: substance use outcomes at three months. Addiction, 92(12), 1717-1728.

O'Malley, S.S., Jaffe, A.J., Chang, G., Schottenfeld, R.S., Meyer, R.E., & Rounsaville, B. (1992). Naltrexone and coping skills therapy for alcohol dependence: A controlled study. Archives of General Psychiatry, 49(11), 881-887.

Sanchez-Craig, M., & Walker, K. (1982). Teaching coping skills to chronic alcoholics in a coeducational halfway house: I. Assessment of programme effects. British Journal of Addiction, 77(1), 35-50.

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