Washington State Institute for Public Policy
Brief intervention for youth in medical settings
Substance Use Disorders: Early Intervention
Benefit-cost estimates updated May 2017.  Literature review updated February 2015.
This category of treatment for youth using alcohol, marijuana, or other drugs is defined by several features: (1) substance abusing youth are identified in primary care or emergency department settings, often using a structured substance abuse screening instrument, and (2) interventions are brief, typically one session of less than one hour duration, and often utilize motivational interviewing techniques.
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 $136 Benefits minus costs $73
Participants $272 Benefit to cost ratio $1.22
Others $163 Chance the program will produce
Indirect ($165) benefits greater than the costs 49 %
Total benefits $406
Net program cost ($333)
Benefits minus cost $73
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 $10 $0 $27 $5 $42
Labor market earnings associated with high school graduation $133 $293 $135 $0 $562
Health care associated with alcohol abuse or dependence $7 $1 $7 $4 $19
Property loss associated with alcohol abuse or dependence $0 $0 $1 $0 $1
Costs of higher education ($15) ($22) ($7) ($7) ($51)
Adjustment for deadweight cost of program $0 $0 $0 ($166) ($166)
Totals $136 $272 $163 ($165) $406
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $328 2014 Present value of net program costs (in 2016 dollars) ($333)
Comparison costs $0 2014 Cost range (+ or -) 10 %
These interventions typically take place during a single visit to a primary care or emergency department setting. We estimate the per-participant cost for youth based on similar programs for adults. For primary care, we use the estimate from 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. In emergency departments, we use a cost estimate from a study in Washington State of $53 per person screened. O’Neil, S. (2006). Expanding the continuum— Improving care: Washington State brief intervention and referral to treatment program, paper delivered at the Co-occurring Disorder Conference. In the collection of studies in our meta-analysis, 11,613 patients were screened to identify 2,171 youth eligible for the intervention. Our cost estimate is weighted by the numbers in treatment groups in these 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
Cannabis use in high school 4 596 -0.025 0.113 18 -0.003 0.170 20 -0.025 0.825
Youth binge drinking 5 854 -0.099 0.068 17 -0.014 0.102 19 -0.099 0.145
Citations Used in the Meta-Analysis

Bernstein, E., Edwards, E., Dorfman, D., Heeren, T., Bliss, C., & Bernstein, J. (2009). Screening and brief intervention to reduce marijuana use among youth and young adults in a pediatric emergency department. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 16(11), 1174-85.

Bernstein, J., Heeren, T., Edward, E., Dorfman, D., Bliss, C., Winter, M., & Bernstein, E. (2010). A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 17(8), 890-902.

D'Amico, E.J., Miles, J.N.V., Stern, S.A., & Meredith, L.S. (2008). Brief motivational interviewing for teens at risk of substance use consequences: A randomized pilot study in a primary care clinic. Journal of Substance Abuse Treatment, 35(1), 53-61.

Haller, D.M., Meynard, A., Lefebvre, D., Ukoumunne, O.C., Narring, F., & Broers, B. (2014). Effectiveness of training family physicians to deliver a brief intervention to address excessive substance use among young patients: a cluster randomized controlled trial. Canadian Medical Association Journal, 186, 8.

Spirito, A., Monti, P.M., Barnett, N.P., Colby, S.M., Sindelar, H., Rohsenow, D.J., . . . Myers, M. (2004). A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department. The Journal of Pediatrics, 145(3), 396-402.

Walton, M.A., Chermack, S.T., Shope, J. T., Bingham, C.R., Zimmerman, M.A., Blow, F.C., & Cunningham, R.M. (2010). Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial. Jama, 304(5), 527-35.

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