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Supportive-expressive psychotherapy for substance use disorders

Substance Use Disorders: Treatment for Adults
Benefit-cost methods last updated December 2019.  Literature review updated May 2014.
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Supportive-expressive psychotherapy (SEP) is a manualized, time-limited psychotherapy originally developed for treating psychiatric disorders that has been adapted for use with individuals with heroin and cocaine addictions. In the studies reviewed for this analysis, clients also had co-morbid psychiatric disorders. SEP generally lasts about six months and is provided in an individual format with two components: (1) supportive techniques to allow patients to feel comfortable discussing experiences, and (2) an expressive component to help patients to understand problematic relationship patterns.
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2018). 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 $3,622 Benefits minus costs $4,660
Participants $9,196 Benefit to cost ratio $3.17
Others ($328) Chance the program will produce
Indirect ($5,686) benefits greater than the costs 56 %
Total benefits $6,805
Net program cost ($2,145)
Benefits minus cost $4,660

^WSIPP’s benefit-cost model does not monetize this outcome.

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. See Estimating Program Effects Using Effect Sizes for additional information.

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 Treatment age 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
Crime
Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.
 36 2 89 0.157 0.309 36 0.000 0.000 39 0.157 0.611
Alcohol use disorder
Clinical diagnosis of alcohol use disorder or symptoms measured on a validated scale.  
 36 3 176 -0.057 0.126 36 0.000 0.000 39 -0.057 0.652
Employment
Any employment, including part-time work.
36 2 89 0.364 0.245 36 0.000 0.000 39 0.364 0.138
Major depressive disorder
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 36 3 180 -0.056 0.242 36 0.000 0.000 39 -0.056 0.953
Illicit drug use disorder
Clinical diagnosis of illicit drug use disorder or symptoms measured on a validated scale. When possible, we exclude cannabis/marijuana use disorder from this outcome.
 36 3 213 0.161 0.150 36 0.000 0.187 39 0.161 0.211
Anxiety disorder
Clinical diagnosis of an anxiety disorder (e.g., general anxiety, panic, social anxiety, obsessive compulsive disorder) or symptoms measured on a validated scale.
 36 2 123 0.120 0.143 36 0.000 0.000 39 0.120 0.401
Psychiatric symptoms^
Mental health symptoms (such as symptoms of psychosis) in individuals with serious mental illness, measured on a validated scale.
 36 3 180 -0.146 0.215 36 n/a n/a n/a -0.146 0.497
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
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Crime Criminal justice system ($4) $0 ($11) ($2) ($17)
Alcohol use disorder Property loss associated with alcohol abuse or dependence $0 $0 $1 $0 $1
Mortality associated with alcohol $0 $0 $0 $3 $4
Employment Labor market earnings $3,956 $9,293 $0 ($1,978) $11,271
Major depressive disorder Health care associated with major depression $9 $3 $10 $5 $26
Illicit drug use disorder Health care associated with illicit drug abuse or dependence ($318) ($49) ($326) ($159) ($852)
Mortality associated with illicit drugs ($22) ($51) $0 ($2,482) ($2,555)
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($1,073) ($1,073)
Totals $3,622 $9,196 ($328) ($5,686) $6,805
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,979 2013 Present value of net program costs (in 2018 dollars) ($2,145)
Comparison costs $0 2013 Cost range (+ or -) 20 %
Supportive-expressive psychotherapy lasts about six months. The per-participant cost of treatment is the weighted average estimate of the individual sessions provided in the studies included in the analysis. We calculated this average estimate using Washington's Medicaid hourly reimbursement rate for outpatient individual therapy multiplied by the weighted average of the total hours of therapy across the studies (averaging 25 total hours). The costs of this intervention are in addition to the individual drug counseling and methadone treatment 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.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative 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 discounted dollars. 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.

Citations Used in the Meta-Analysis

Crits-Christoph, P., Siqueland, L., McCalmont, E., Frank, A., Blaine, J., Weiss, R.D., …, Thase, M.E. (2001). Impact of Psychosocial Treatments on Associated Problems of Cocaine-Dependent Patients. Journal of Consulting and Clinical Psychology, 69(5), 825-830.

Crits-Christoph, P., Siqueland, L., Blaine, J., Frank, A., Luborsky, L., Onken, L. S., …, Beck, A.T. (1999). Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Archives of General Psychiatry, 56(6), 493-502.

Woody, G.E., Luborsky, L., McLellan, A.T., O'Brien, C.P., Beck, A.T., Blaine, J., Herman, I., Hole, A. (1983). Psychotherapy for opiate addicts: Does it help?. Archives of General Psychiatry, 40(6), 639-645.

Woody, G.E., McLellan, A.T., Luborsky, L. & OBrien, C.P. (1995). Psychotherapy in Community Methadone Programs: A Validation Study. American Journal of Psychiatry, 152(9), 1302-1308.