The Cost Effectiveness of Early Intervention for Substance Abuse
Between one third and one-half of individuals sustaining a traumatic brain injury are intoxicated at the time of the injury, and almost two-thirds of adolescents and adults admitted to brain injury rehabilitation programs have a history of substance abuse. Case management for the treatment of substance abuse following brain injury has been piloted in several states based on a model of treatment developed at Ohio State University. While recent reports suggest that persons two years post-injury increase their substance use, evaluations of the OSU treatment model suggest that clients started early post-injury are more likely to drop out of treatment. The purpose of the current study is to evaluate the cost effectiveness for persons with traumatic brain injuries of early versus late treatment of substance abuse using a case management model. The early group will be those individuals who initiate treatment within one year post-injury; the late group will be those initiating treatment two to five years post-injury. Outcomes after nine months of treatment will be compared between groups, as well as with a control sample of subjects with comparable substance abuse problems, matched for time post-injury, who did not receive case management. Cost per client (based on staff contact hours) of changes in substance use, community integration, and subjective well-being will be compared between early and late groups. Subjects will be drawn from a multi-center study funded by the Center for Disease Control and Prevention, with treated groups drawn from programs at Ohio State University and Wright State University, and control subjects from the Rehabilitation Institute of Chicago.