Date of Award

Fall 2004

Document Type

Dissertation - Restricted

Degree Name

Doctor of Philosophy (PhD)




Research in addictions treatment has shown that traditional approaches to serving persons with substance misuse disorders are ineffective in two of three people who receive treatment. This poor efficacy is associated with high rates of recidivism in some populations. Harm reduction has been proposed as an alternative or additional approach to treating addictions that emphasizes low threshold access to clinical services. This is in opposition to the predominant treatment models, which are based on the Medical/Disease and Moral models of substance misuse. The purpose of the current study is to evaluate an outpatient substance abuse treatment program, the Treatment Alternative Group (TAG), based on a harm reduction model. This evaluation was approached from a cost-efficacy and service utilization perspective. Data was collected from two groups of veterans, including TAG members (Experimental Group) and a comparison group of veterans who would have been eligible for the program had it been available in the past. Preliminary analyses indicated that the groups were well matched on demographic and clinical profiles, although there were relatively fewer African-American participants in the Experimental Group. Groups were compared on costs associated with inpatient and outpatient mental health care and outpatient medical care in the time periods immediately before and after joining the TAG (Experimental Group) or becoming eligible for the group (Comparison Group). Admission rates and average length of stay per admission were also compared. Results indicated that Experimental Group participants demonstrated a significant decrease in costs of inpatient mental health and outpatient medical care. The number of inpatient psychiatric admissions and average length of stay per admission were also significantly reduced following admission to the TAG. Similar reductions were not observed in the Comparison Group. Although the Experimental Group incurred significantly higher inpatient psychiatric costs in the pre-TAG period, the groups were not different in the post-TAG period. While the current study had several limitations, these results are interpreted as strong preliminary evidence for the efficacy of the TAG, notably the harm reduction aspects of the program. Limitations of the current study and suggestions for future research in this area are also discussed.



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