Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Prevention 

Substance Abuse Prevention Dollars and Cents: 

A Cost-Benefit Analysis 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Prevention

www.samhsa.gov
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis

Substance Abuse Prevention Dollars and 

Cents: A Cost-Benefit Analysis 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Prevention
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

ACKNOWLEDGMENTS 

Numerous people contributed to the development of this document (see Appendix, 9.4). The 

document was prepared for the Substance Abuse and Mental Health Services Administration 

(SAMHSA) by Ted R. Miller, Ph.D., Director, Public Services Research Institute of 

Pacific Institute for Research and Evaluation, and Delia Hendrie, Ph.D., Lecturer, 

University of Western Australia, under contract number 277-00-6112 with SAMHSA, U.S. 

Department of Health and Human Services (HHS). Beverlie Fallik, Ph.D., SAMHSA Center for 

Substance Abuse Prevention (CSAP), served as the Government Project Officer. 

DISCLAIMER 

The views, opinions, and content of this publication are those of the authors and do not 

necessarily reflect the views, opinions, or policies of SAMHSA or HHS. 

PUBLIC DOMAIN NOTICE 

All material appearing in this report is in the public domain and may be reproduced or copied 

without permission from SAMHSA. Citation of the source is appreciated. However, this 

publication may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, and HHS. 

ELECTRONIC ACCESS AND COPIES OF PUBLICATION 

This publication may be downloaded or ordered at www.samhsa.gov/shin. Or, please call 

SAMHSA's Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) (English and 

Español). 

RECOMMENDED CITATION 

Miller, T. and Hendrie, D. Substance Abuse Prevention Dollars and Cents: A Cost-Benefit 

Analysis, DHHS Pub. No. (SMA) 07-4298. Rockville, MD: Center for Substance Abuse 

Prevention, Substance Abuse and Mental Health Services Administration, 2008. 

ORIGINATING OFFICE 

Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services 

Administration, 1 Choke Cherry Road, Rockville, MD 20857 

DHHS Publication No. (SMA) 07-4298 

Printed 2008 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

i

Contents 

1. Executive Summary ............................................................................................................1

1.1. Costs of Substance Abuse...............................................................................................1

1.2. Savings From Effective School-Based Substance Abuse Prevention ...............................1

1.3. Conclusion .....................................................................................................................2

2. Introduction ........................................................................................................................3

2.1. Contents of This Report..................................................................................................3

2.2. Definitions of Cost, Cost-Effectiveness, and Cost Benefit ..............................................4

2.2.1. Cost-Benefit Analysis ...........................................................................................4

2.2.2. Discounting to Present Value ................................................................................4

2.2.3. Assumptions .........................................................................................................5

2.2.4 Using Cost-Benefit Analyses To Guide Program and Strategy Selection ................5

3. Direct Economic Impact of Substance Abuse ....................................................................6

3.1. Current National Estimates of Social Costs.....................................................................6

3.2. Costs of Alcohol and Drug Abuse to States ....................................................................9

4. Costs and Benefits of Preventing Substance Abuse ......................................................... 10

4.1. Youth Delaying or Never Using Substances ................................................................. 10

4.2. National Cost Savings .................................................................................................. 14

4.2.1. Cost-Benefit Ratios ............................................................................................. 17

4.2.2. Cost Savings to States ......................................................................................... 18

5. Cost-Benefit Analyses of Specific Policies and Programs ............................................... 20

5.1. Environmental Interventions......................................................................................... 21

5.2. Youth-, Family-, and School-Based Programs .............................................................. 23

5.3. Programs Exclusively Focused on Tobacco .................................................................. 28

6. Policy Implications and Future Directions ...................................................................... 30

6.1. Prevention Program Packages ...................................................................................... 30

6.1.1. Decisionmaking Based on Aggregate Benefits .................................................... 30

6.1.2. Intervention Overlap ........................................................................................... 31

6.2. Future Directions .......................................................................................................... 31

7. Conclusion ......................................................................................................................... 32

8. References ......................................................................................................................... 34

9. Appendix: Methods .......................................................................................................... 39

9.1. Assumptions................................................................................................................. 39

9.2. Cost Estimation ............................................................................................................ 40

9.3. Benefits Estimation ...................................................................................................... 45
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

ii

Tables 

1 Estimated Economic Cost of Substance Abuse to Society in 1999 ................................................... 7 

2 Cost of Alcohol and Drug Abuse to States in 1998 .......................................................................... 9 

3 High, Medium, and Low Estimates of the Percentage of All Youth Ages 12–14 Whose 

Initiation of Substance Use Would Be Delayed or Prevented Through Participation in Effective 

Nationwide School-Based Prevention Programming ..................................................................... 11 

4 High, Medium, and Low Estimates of the Number of Youth Ages 12–14 Whose Initiation of 

Substance Use Would Be Delayed or Prevented Through Participation in Effective Nationwide 

School-Based Prevention Programming in 2002 .......................................................................... 12 

5 High, Medium, and Low Estimates of the Number of Youth Ages 12–14 Who Would Avoid 

 Past Month Substance Use, Binge Drinking, and Smoking Regularly During 2003 If They 

Participated in Effective Nationwide School-Based Prevention Programming in 2002 .................. 13 

6 Number and Percentage of Youth Ages 13–15 Who Were Using and Abusing Alcohol, 

Marijuana, Cocaine, and Tobacco in 2003, United States, and Reduction Achievable If All 

Had Participated in Effective Nationwide School-Based Prevention Programming in 2002 ........... 14 

7 High, Medium, and Low Estimates of Potential Lifetime Monetary and Total Cost Savings to 

Society From Implementing Effective Nationwide School-Based Prevention Programming 

in 2002 for Youth Ages 12–14, by Type of Substance (in billions) ............................................... 16 

8 High, Medium, and Low Estimates of Potential Total Cost Savings to Society From 

 Implementing Nationwide School-Based Prevention Programming in 2002 for Youth Ages 

 12–17, by Cost Category (in billions)............................................................................................ 16 

9 High, Medium, and Low Estimates of Savings Per Pupil, Cost-Benefit Ratio, and Net Cost 

 Savings From Implementing Nationwide School-Based Prevention Programming in 2002 for 

 Youth Ages 12–14 ....................................................................................................................... 17 

10 High, Medium, and Low Estimates of Potential Near-Term Cost Savings to State and Local 

Governments From Implementing Effective Nationwide School-Based Substance Abuse 

 Prevention Programming in 2002 for Youth Ages 12–14 (in millions) .......................................... 19 

11 Cost-Benefit Ratios and Cost/QALY for Nine Environmental Alcohol and Drug Use/ 

Abuse Interventions (in 2002 dollars) ........................................................................................... 22 

12 Cost-Benefit Ratios and Cost/QALY for 22 School-, Family-, or Community-Based 

Substance Abuse Prevention Programs (in 2002 dollars) ............................................................... 25 

13 Cost-Benefit Ratios and Cost/QALY for Four School- or Community-Based Substance 

Abuse Tobacco Use Prevention Programs (in 2002 dollars) .......................................................... 28 

A1 Reviewed Studies, Intervention Descriptions, Recomputations, and Quality Ratings ..................... 42 

A2 Percentage of Participants Delaying Initiation or Reducing Alcohol, Marijuana, 

Cocaine, and Tobacco Use, and a Meta-Analytic Estimate of the Source of Effectiveness 

for School and Family/Community-Based Prevention Programs ................................................... 47 

A3 Teacher Cost Estimates and Their Sources .................................................................................... 49 

A4 Estimated Program Costs by Component (in 2002 dollars) ............................................................ 50 

A5 Updated Estimates of the Societal Costs of Alcohol and Illicit Drug Abuse That Include Lost 

Quality of Life and Costs to Victims, United States, 2000 (in millions of 2002 dollars) ................. 51 

A6 Factors That Are Multiplied Together To Calculate the Social Benefit From Reduction 

in Substance Use Over a Lifetime ................................................................................................. 52 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

iii

Figures 

1. Total Resource and Productivity Costs of Substance Abuse in Billions for 1999 ............................. 8 

2. State Savings Within 2 Years of Implementation of Effective Programs Using Medium 

 Estimates ...................................................................................................................................... 20 

3. Savings Per Dollar Spent From Nationwide Implementation of Environmental 

 Strategies...................................................................................................................................... 23 

4. Cost-Benefit Ratios for Youth Development Through Integrated Family or Community 

 and School Programs .................................................................................................................... 27 

5. Cost-Benefit Ratios for School-Based Prevention Programs (in 2002 dollars) ............................... 29
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis

1

1.Executive Summary 

Policymakers and other stakeholders can use cost-benefit analysis as an informative tool for 

decisionmaking for substance abuse prevention. This report reveals the importance of 

supporting effective prevention programs as part of a comprehensive substance abuse 

prevention strategy. The following patterns of use, their attendant costs, and the potential cost 

savings are analyzed: 

Extent of substance abuse among youth 

Costs of substance abuse to the Nation and to States 

Cost savings that could be gained if effective prevention policies, programs, 

and services were implemented nationwide 

Programs and policies that are most cost beneficial 

1.1. Costs of Substance Abuse 

Studies have shown the annual cost of substance abuse to the Nation to be $510.8 billion in 

1999 (Harwood, 2000). More specifically, 

Alcohol abuse cost the Nation $191.6 billion. 

Tobacco use cost the Nation $167.8 billion. 

Drug abuse cost the Nation $151.4 billion. 

Substance abuse clearly is among the most costly health problems in the United States. 

Among national estimates of the costs of illness for 33 diseases and conditions, alcohol 

ranked second, tobacco ranked sixth, and drug disorders ranked seventh (National Institutes 

of Health [NIH], 2000). This report shows that programs designed to prevent substance abuse 

can reduce these costs. 

1.2. Savings From Effective School-Based Substance Abuse Prevention 

If effective prevention programs were implemented nationwide, substance abuse initiation 

would decline for 1.5 million youth and be delayed for 2 years on average. It has been well 

established that a delay in onset reduces subsequent problems later in life (Grant & Dawson, 

1997; Lynskey et al., 2003). In 2003, an estimated: 

8 percent fewer youth ages 13 to 15 would not have engaged in binge drinking 

11.5 percent fewer youth would not have used marijuana 

45.8 percent fewer youth would not have used cocaine 

10.7 percent fewer youth would not have smoked regularly 

The average effective school-based program in 2002 costs $220 per pupil including materials 

and teacher training, and these programs could save an estimated $18 per $1 invested if 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

2

implemented nationwide. Nationwide, full implementation of school-based effective 

programming in 2002 would have had the following fiscal impact: 

Saved State and local governments $1.3 billion, including $1.05 billion in educational 

costs within 2 years 

Reduced social costs of substance-abuse–related medical care, other resources, and lost 

productivity over a lifetime by an estimated $33.5 billion 

Preserved the quality of life over a lifetime valued at $65 billion 

Although 80 percent of American youth reported participation in school-based prevention in 

2005 (SAMHSA, 2004), only 20 percent were exposed to effective prevention programs 

(Flewelling et al., 2005). Given this level of participation, it is possible that some expected 

benefits already exist for these students, and the estimates in this paper are adjusted for these 

probable benefits. These cost-benefit estimates show that effective school-based programs 

could save $18 for every $1 spent on these programs. 

Table A1 in the appendix lists 35 effective prevention programs and strategies and the 

estimated cost-benefit ratios for each program. The array of demonstrated effectiveness 

among prevention programs and strategies is impressive. Of the 35 substance abuse 

prevention programs, practices, or related interventions, 15 reduced medical, criminal justice, 

and other spending by more than the cost to implement the program. 

In a program targeting families with low income, intensive home visitation coupled with 

preschool enrichment reduced infant/toddler abuse (Aos et al., 1999; Karoly et al., 1998). As 

these toddlers reach adolescence and adulthood, visitation programs also can reduce a range 

of problems including substance abuse and violence. 

Among indicated programs (targeted to individuals who have detectable symptoms), cost 

estimates that primarily focused on substance abuse were not available. However, estimates 

indicating good returns on the investment were available for several violence prevention 

interventions that address the roots of multirisk behavior. Moral reconation therapy for adult 

and youth offenders, and multisystemic therapy and functional family therapy for youth 

offenders returned more than $30 per dollar invested. 

1.3. Conclusion 

The cost of substance abuse could be offset by a nationwide implementation of effective 

prevention policies and programs. SAMHSA’s Strategic Prevention Framework should 

include a planning step that considers cost-benefit ratios. Communities should consider a 

comprehensive prevention strategy based on their unique needs and characteristics and use 

cost-benefit ratios to help guide their decisions. Model programs should include data on costs 

and estimated cost-benefit ratios to help guide prevention planning. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

3

2.Introduction 

Historically, cost-benefit analyses have enabled policy and program managers to make 

informed decisions about resource allocations for substance abuse treatment policies, 

programs, and practices. Such analyses also can inform decisionmaking for substance abuse 

prevention. This report provides the best estimates of the magnitude of the costs to society 

from substance abuse and the costs and benefits gained through effective prevention. The 

report draws on the data and methods of recent substance abuse costs and cost savings 

studies. The overarching goal is to provide a broader base from which to understand the costs 

of substance abuse prevention programs and the potential cost savings as a result of 

implementation. 

Increasingly, the American public supports investment in prevention programs as a strategy 

for dealing with America’s substance abuse problems (Blendon & Young, 1998; Maguire & 

Pastore, 1996). Research demonstrates that substance abuse prevention programs work: they 

can reduce rates of substance use and can delay the age of first use. Studies also have shown 

that prevention programs not only prevent substance abuse; they can contribute to cost 

savings (Aos et al., 2004; Caulkins et al., 2002; Miller & Hendrie, 2005; Swisher et al., 

2003).

2.1. Contents of This Report 

Section 3 of this report summarizes existing estimates of the costs of substance abuse and its 

damaging consequences. These cost estimates are used to evaluate the benefits of prevention 

in existing cost-benefit analyses and are available for use in new analyses. The estimates 

reviewed highlight the total annual costs of substance abuse from a number of perspectives 

including social costs and the direct costs to State government. The social perspective 

includes everyone’s costs and benefits: people who abuse substances, family members, the 

general public, communities, and all levels of government (Federal, State, and local). 

Section 4 analyzes the probable outcomes of implementing school-based substance abuse 

prevention programming nationwide in 2002 for youth ages 12–17. The report first documents 

existing levels of substance abuse among youth and then develops composite estimates of the 

approximate program costs for school-based programs and the probable impact on substance 

abuse. 

Section 5 summarizes existing costs and benefits of substance abuse and related prevention 

programs from society’s perspective. It draws heavily on two systematic evaluations of costsavings estimates, adds new analyses, and includes many programs listed on SAMHSA’s 

National Registry of Evidence-based Programs and Practices (NREPP). These cost-savings 

analyses show that savings from substance abuse prevention generally exceed the costs of 

prevention programs. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

4

Section 6 suggests how the estimates in Section 5 might be used to create an integrated, 

comprehensive, and highly cost-effective approach to substance abuse prevention and also 

suggests directions for future work. Section 7 provides a concise conclusion to this report. 

2.2. Definitions of Cost, Cost-Effectiveness, and Cost Benefit 

The economic literature uses a variety of definitions for cost, cost-effectiveness, and cost 

benefit. However, for the purposes of this report, each of these terms is defined below: 

1.

2.

3.

Costs are defined as expenditures to deliver services and expenditures to receive 

services (Chatterji et al., 2001). 

Cost-effectiveness is defined as expenditures required to achieve an effect 

(Hurley, 1990). 

Cost benefit is defined as the ratio between expenditures to deliver a program and the 

reduced social costs over time as a result (Plotnick, 1994). 

2.2.1. Cost-Benefit Analysis 

A cost-benefit analysis places dollar values on all significant outcomes, including death, pain 

and suffering, and property loss, so that benefits are directly compared with costs in 

monetary terms. Reporting costs and outcomes in a common metric facilitates comparison 

among diverse programs, and allows the benefits to be clearly distinguished from the costs. 

However, valuing the quality-adjusted life year (QALY) losses in dollars is methodologically 

challenging and controversial. 

As well as reporting the ratio of benefits to costs, a cost-benefit analysis typically provides a 

net benefits estimate, which is computed by subtracting the cost of intervention from the 

benefits of the intervention (Mishan, 1988). For example, the All Stars program has a costbenefit ratio of 34:1 (see Table 12), which means it returns $34 dollars in savings for every 

dollar invested, yielding net benefits of $4,670 per pupil ($4,810 in social cost savings minus 

$140 in program costs). By comparison, the Life Skills Training program has a cost-benefit 

ratio of 21:1 and yields net benefits of $4,380 per pupil. 

Although the All Stars and Project Northland programs save more than it costs to develop 

and deliver them, the return on investment in All Stars is 34:1, and the return on Project 

Northland is just 17:1. However, other factors should be considered, e.g., the level of 

outcome and long-term effects. For example, Project Northland also involves developing a 

community coalition that remains after the program and can address related issues without 

additional costs. In allocating resources, analysts often trade off the most efficient 

investments—those with the highest cost-benefit ratios against those with a broader reach 

that can produce a larger total benefit. 

2.2.2. Discounting to Present Value 

A basic concept underlying any cost-benefit analysis is that intervention delays or prevents 

costs in the current year and in the future. Because money earns interest even in the absence of 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

5

inflation, if a dollar must be paid in 5 years, one could invest less than a dollar today in order to 

cover that expense (Hargreaves et al., 1998). 

The generally accepted practice is to adjust future costs to their present value by applying a 

discount rate (Gold et al., 1996). The discount rate is essentially the reverse of an interest rate. 

Whenever possible, this report uses the 3 percent discount rate recommended by the Panel on 

Cost-Effectiveness in Health and Medicine (Gold et al., 1996) and the U.S. Office of 

Management and Budget (OMB, 2003). As recommended, this rate is used to discount all 

future costs and benefits, including QALY gains (Gold et al., 1996; OMB, 2003; Keeler & 

Cretin, 1983). 

2.2.3. Assumptions 

This report made the following assumptions: 

Estimates of effectiveness from Table 4 apply to U.S. youth ages 12 to 14 

(9.483 million). 

The impact was reduced by 25 percent to account for reduced intervention effectiveness 

as one scales up from controlled demonstrations to full-field implementation 

(Aos et al., 1999; Greenwood et al., 1996; Miller and Levy, 2000). 

Youth would not be participating in two effective family/community-based prevention 

programs at the same time. 

Benefits apply to youth who actually participated in effective school-based substance 

abuse prevention programs in 2002. 

Costs or benefits were determined by estimates from Table 4, and ratios from the 2003 

YRBS of (1) current to lifetime users by substance, (2) binge drinkers during the past 

month to lifetime drinkers, and (3) youth smoking on at least 20 of the past 30 days to 

lifetime. 

Substance abuse costs decline in proportion to delays in initiation as a result of 

prevention programming. 

Total costs equal the monetary costs plus the value of pain, suffering, and loss in quality 

of life. Estimates are the product of the costs in Table 1 and the percentages in Table 3. 

Benefits accrue over a multiyear period, and future costs can be converted to present 

value using a 3 percent discount rate. 

Costs from substance abuse among youth decline at the same rate as the number of those 

who initiate use. 

Savings from existing school-based programs are included in these estimates. 

2.2.4 Using Cost-Benefit Analyses To Guide Program and Strategy Selection 

Cost-benefit analyses respond to only one consideration in selecting programs and strategies 

for reducing substance abuse and its costs to society. The estimates in this report eliminate 

interventions that offer a questionable return on investment and should be used to guide 

choices between interventions that score comparably on other criteria. However, as discussed 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

6

in detail in Section 6, when selecting interventions, policymakers also must consider political 

feasibility, local priorities, appropriateness for the target population, affordability, and the 

immediacy of the impact (weeks versus years). 

3.Direct Economic Impact of Substance Abuse 

NIH ranks alcohol second, tobacco sixth, and drug disorders seventh among estimated costs 

of illness for 33 diseases and conditions (NIH, 2000). The year 1999 is the most recent year, 

with estimates available for all three categories of substance abuse. Despite a smaller number 

of deaths from alcohol use, alcohol-related costs are greater than tobacco costs because 

alcohol-related mortality tends to occur at younger ages than smoking-related mortality. 

The categories used to develop the alcohol and drug abuse estimates include specialty 

alcohol and drug services; medical consequences; lost earnings due to premature death; lost 

earnings due to substance-abuse–related illness; goods or services related to crashes, fires, 

criminal justice, other; and lost earnings resulting from crime. The categories used to develop 

the smoking estimates were medical consequences and lost earnings due to morbidity and 

premature death. Tobacco prevention costs are excluded; the largest share of these prevention 

costs, State spending, averages $600 million annually (Campaign for Tobacco-Free Kids, 

2004). 

3.1. Current National Estimates of Social Costs 

For 1999, the Department of Health and Human Services estimates the annual total resource 

and productivity cost of substance abuse at $510.8 billion (see Table 1) (Harwood, 2000; 

Harwood & Bouchery, 2001; Fellows et al., 2002). Adjusted for population and wage/price 

trends in the 1990s, the estimates provide an overview of the social costs of substance abuse 

in terms of lost goods, lost productivity, treatment, and medical services. Extensive data that 

track substance use and abuse show moderate changes (both increases and decreases) in their 

prevalence during that period. The studies cited here factored these changes into their 

updated estimates. 

Table 1 shows the social cost of alcohol, tobacco, and drug abuse in the United States by 

substance. Alcohol abuse was responsible for $191.6 billion (37.5 percent) of the $510.8 

billion, tobacco use was responsible for $167.8 billion (32.9 percent), and drug abuse was 

responsible for $151.4 billion (29.6 percent). Almost all of these costs are a result of the 

following events: 

Resource costs of substance abuse: Costs related to substance abuse include treatment and 

prevention, medical care, police, fire department, adjudication, and sanctioning expenses, 

Substance abuse ranks among 

the top 10 health problems in 

the United States. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

7

as well as property damage and related expenses associated with crime, motor vehicle 

crashes, and fires involving alcohol (Harwood & Bouchery, 2001). 

Loss of potential productivity and earnings: Smoking accounted for almost 440,000 

deaths in 1999 (Fellows et al., 2002), alcohol abuse accounted for 42,000 (Harwood, 

2000) to 76,000 deaths (Midanik et al., 2004), and drug abuse accounted for an additional 

23,000 deaths (Harwood & Bouchery, 2001). Additional productivity losses occurred 

when individuals who abused substances did not work (e.g., were sick, unemployed, or in 

prison), or were impaired or disabled. 

Table 1: Estimated Economic Cost of Substance Abuse to Society in 1999 

(in billions)1 

Substance Abuse Alcohol Tobacco Drugs Total

Resource Costs

Specialty treatment and prevention 

services

7.8 N/A 7.6 15.4

Treatment of medical consequences 20.0 75.9 5.4 101.3

Goods and services related to crashes, 

fires, crime, criminal justice

24.4 N/A 31.1 55.5

Total Resource Costs 172.2

Productivity Costs

Work loss due to premature death 37.4 81.9 20.9 140.2

Work loss due to illness related to 

substance abuse

91.1 10.0 26.7 127.8

Work loss by crime victims 1.0 N/A 2.0 3.0

Work loss by perpetrators due to 

incarceration and criminal careers

9.9 N/A 57.7 67.6

Total Productivity Costs 338.6

Total Resource and Productivity 

Costs

191.6 167.8 151.4 510.8

_______________________________________________ 

1

Sources: For alcohol, Harwood (2000), trend-adjusted from 1998 to 1999; for tobacco, Fellows et al., (2002) except illness 

earnings loss from Harwood & Bouchery (2001); for other drugs, Harwood & Bouchery (2004). Similar costs are incurred 

annually. State prevention spending driven by tobacco settlement funds is the bulk of prevention spending. It averages $0.6 

billion annually (Campaign for Tobacco-Free Kids, 2004).

The total annual costs to society for 

substance abuse are $510.8 billion.
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

8

Figure 1: Total Resource and Productivity Costs of Substance Abuse in Billions for 1999 

This pie chart compares the social costs of alcohol, tobacco, and other drug use. 

$191.6 $151.4

29.6% 37.5%

$167.8

32.9%

Alcohol Tobacco Other Drugs

Lost productivity makes up two-thirds of the costs of substance abuse. Lifetime wage and 

household work lost to premature death is the largest component of these costs, followed 

closely by work lost to acute and chronic illness and injury. Incarceration results in $32 

billion in earnings losses. Almost $25 billion more is lost when people who abuse substances 

pursue criminal careers rather than enter the labor force. 

These estimates are conservative; they omit some costs that result from substance abuse. 

Specifically, they exclude (1) the impact on the quality of life of those who abuse substances 

and the people they harm and (2) the health care costs and work losses of victims who were 

involved in alcohol-attributable crashes even though they had not been drinking. These 

estimates also exclude the impact on the quality of life, although the Federal Government has 

set a precedent for including this impact. For example, the U.S. Office of Management and 

Budget (OMB, 2002) requires cost-benefit analyses of health-related regulatory proposals to 

include a monetized or nonmonetized measure of the loss in quality of life. French and 

colleagues (1996) make a similar recommendation specifically for analyses of substance 

abuse prevention. Finally, some economists (e.g., Cohen, 1998) suggest including spending 

on substances of abuse, or at least on illegal sales, including purchase price and travel costs. 

Like all the substance abuse cost and cost-savings estimates in this paper, Table 1 omits the 

purchase price. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

9

3.2. Costs of Alcohol and Drug Abuse to States 

The National Center on Addiction and Substance Abuse (NCASA, 2001) reported the cost of 

substance abuse to States.2 As shown in Table 2, the total cost in 1998 was an estimated 

$81.3 billion.3 The greatest expenses were justice (adult corrections, juvenile justice, 

judiciary), education (elementary, secondary), health (primarily Medicaid), child/family 

assistance (child welfare, income assistance), and mental health/developmentally disabled. 

However, the total cost does not account for actual savings in Medicaid spending. On 

average, because people who abuse substances die earlier, they use public health services less 

(Manning et al., 1991). 

Table 2: Cost of Alcohol and Drug Abuse to States in 1998 (in millions of 1998 dollars)4 

Type of Cost Cost

Prevention, Treatment and Research $ 3,011

Justice 30,655

Education (Elementary/Secondary) 16,498

Health 15,167

Child/Family Assistance 7,722

Mental Health/Developmentally Disabled 5,888

Public Safety 1,507

State Workforce 408

Regulation/Compliance 433

TOTAL $81,289

_______________________________________________ 

2After a review of the literature on substance abuse costs and consequences to government programs, NCASA selected five 

States (California, Florida, Minnesota, New Jersey, and Vermont) for site visits with State budget and program officials to 

understand how programs are financed and how best to gather spending data. With input from the five model States, NCASA 

analysts developed a questionnaire designed to collect data on revenues, expenditures, and all costs for the State fiscal year 

1998. This questionnaire was pretested with three States and ultimately administered to 45 States, Puerto Rico, and the 

District of Columbia. Costs for the remaining States were estimated by assuming mean costs per capita in responding States 

were representative of costs in similar non-responding States. 

3

Section 4 illustrates one way to use these estimates to help understand prevention savings. 

4

Source: NCASA, 2001. 

States spend another $81.3 

billion on substance abuse.
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

10

4.Costs and Benefits of Preventing Substance Abuse 

This section uses the percentage of youth who might have started using substances in the 

United States and published estimates of prevention effectiveness to analyze the probable 

impact of a nationwide implementation of effective school-based substance abuse prevention 

programming. The following were estimated: 

Potential reduction in substance use and abuse as a result of providing effective schoolbased prevention interventions to all U.S. youth ages 12–14 in middle school 

Potential social cost savings as a result of providing effective school-based prevention 

interventions to all U.S. youth ages 12–14 

Social return on investment in preventive intervention measured in terms of costs and 

benefits 

Potential State government savings in juvenile justice and education costs as a result of 

providing effective school-based prevention interventions to all U.S. youth ages 12–14 

The analyses primarily draw on data from the following sources: 

A report by Caulkins and colleagues (1999) for RAND titled An Ounce of Prevention, a 

Pound of Uncertainty: The Cost-Effectiveness of School-Based Drug Prevention 

Programs

The NCASA report titled Shoveling Up: The Impact of Substance Abuse on State Budgets

(NCASA, 2001) 

National Survey on Drug Use and Health (NSDUH) (SAMHSA, 2004)) 

Youth Risk Behavior Survey (YRBS) (Centers for Disease Control and Prevention, 2003) 

Two meta-analyses on the effectiveness of school-based youth substance abuse 

prevention programs (Aos et al., 2004; Hansen et al., 2004) 

Table 3 (percentage of youth who delay initiation of substance abuse) 

4.1. Youth Delaying or Never Using Substances 

Nearly every youth ages 12–14 is at risk for trying alcohol, tobacco, and drugs and may be 

aware of social norms and feel peer pressure to start using these substances. The initial 

analysis involved estimating the number of youth who would not have tried or would not 

regularly use these substances if effective school-based prevention programs were in place 

nationwide. To determine these estimates, the number of youth ages 12–14 was multiplied by 

three factors: the low, medium, and high estimates of the percentage of youth who would 

delay initiating use of each substance if they received effective school-based prevention 

programming. The effectiveness estimates were drawn from two meta-analyses on the 

effectiveness of school-based youth substance abuse prevention programs (Aos et al., 2004; 

Hansen et al., 2004). 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

11

Table 3 shows the range of estimates of effectiveness. The midrange estimates of youth 

receiving effective school-based prevention services across intervention programs are as 

follows: 

4.7 percent will delay using alcohol 

4.1 percent will delay using marijuana 

2.7 percent will delay using cocaine 

4.7 percent will delay smoking 

These estimates represent the mean values from an array of school-based prevention 

programs that evaluations found significantly (>.05) delayed or prevented initiation of youth 

substance use. The individual estimates of effectiveness were derived from meta-analyses 

that generally excluded evaluations that did not use some sort of comparison or control 

group. Prevention programs for cocaine use had the smallest range of effectiveness from 2.3 

percent to 5.3 percent of youth delaying or never initiating use. Prevention programs that 

delayed or prevented initiation of alcohol use had the greatest range of 1 percent to 10.3 

percent. 

Table 3: High, Medium, and Low Estimates of the Percentage of All Youth Ages 

12–14 Whose Initiation of Substance Use Would Be Delayed or Prevented Through 

Participation in Effective Nationwide School-Based Prevention Programming 

Substance

Range of Percentage of Youth Delaying Initiation or Never Initiating

Low Estimate Medium Estimate High Estimate

Alcohol 1.0 4.7 10.3

 Basis for assumed

 effectiveness

lowest of 9 nonzero 

estimates5 mean of 10 estimates highest of 10 estimates

Marijuana 1.9 4.1 6.8

 Basis for assumed

 effectiveness

lowest of 8 nonzero 

estimates mean of 9 estimates highest of 9 estimates

Cocaine 2.3 2.6 5.3

 Basis for assumed

 effectiveness

lowest of 6 nonzero 

estimates mean of 8 estimates highest of 8 estimates

Tobacco 2.0 4.6 8.8

 Basis for assumed

 effectiveness

lowest of 8 nonzero 

estimates mean of 9 estimates highest of 9 estimates

_______________________________________________ 

5Nonzero means that the outcome had a numeric value greater than zero. Assumption: Means for each outcome measure 

ignore the 11 evaluated school-based substance abuse interventions and 3 tobacco-only interventions that had an insignificant 

or unknown effect on outcome. Medians differ from the means by no more than 0.3 percent, e.g., 4.2 percent versus 4.5 

percent for marijuana. See Table A2 for the estimates of effectiveness by intervention used in constructing this table. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

12

Table 4 shows a range of estimates of the number of youth who would delay substance use if 

they received effective school-based prevention programming. For all youth ages 12–14, 

universal prevention programming in 2002 would have delayed 1.5 million initiations of 

substance use, with a range from 0.7 to 3 million. The largest absolute impact would be on 

drinking, with 446,000 youth delaying their first drink, followed closely by smoking with 

436,000 youth delaying their first smoke. (A youth who delays both smoking and drinking is 

counted in both categories.) For drug abuse, the corresponding estimates are 247,000 youth 

delaying their first cocaine use and 389,000 delaying their first use of marijuana. 

An analysis of NSDUH data by Caulkins and colleagues (2002) suggests the delay in 

initiating use as a result of effective prevention services would average 2 years, with some 

youth never initiating. Importantly, according to NSDUH, an estimated 80 percent of youth 

ages 12–17 actually participated in some form of education about drugs and alcohol in 2004, 

but only 20 percent were exposed to effective prevention programs (Flewelling, 2005). To 

the extent that these programs are operating effectively, it is possible that as much as half of 

the potential prevention savings may already have been realized. These already realized 

savings are subtracted from the savings estimates in this report. 

The rationale for this analysis is that when youth delay onset of substance use, on average, 

two years less of lifetime use occurs. When prevention programs delay the onset of substance 

use, the number of future dependent users also decreases (Grant & Dawson, 1997), but the 

analysis does not estimate that further saving. 

Table 4: High, Medium, and Low Estimates of the Number of Youth Ages 12–14 Whose 

Initiation of Substance Use Would Be Delayed or Prevented Through Participation 

6

in Effective Nationwide School-Based Prevention Programming in 2002 

Substance Low Estimate Medium Estimate High Estimate

Alcohol 95,000 446,000 977,000

Marijuana 180,000 389,000 645,000

Cocaine 218,000 247,000 503,000

Tobacco 190,000 436,000 835,000

Total 683,000 1,518,000 2,960,000

_______________________________________________ 

6

Product of the U.S. population ages 12–14 of 9.483 million and the estimates of effectiveness from Table 3. The estimates at 

all levels were reduced by 25 percent to account for reduced intervention effectiveness as the implementation moves from 

demonstration to full implementation (Greenwood et al.,1996; Miller and Levy, 2000; and Aos et al.,1999).
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

13

Many youth who try using substances do not regularly use or abuse substances immediately. 

To determine these estimates, the number of youth in Table 4 who delayed initiating 

substance use was multiplied by substance-specific ratios of current users and regular/heavy 

users from the 2003 Youth Risk Behavior Survey (YRBS). The estimates are given for 

specific substances: 

Illicit drugs (past month use of cocaine and marijuana) 

Alcohol (past month use, binge drinking: 5 or more drinks at 1 time in the past month) 

Cigarettes (past month use, regular smoking: use on at least 20 days in the past month) 

Effective nationwide school-based prevention programming for youth ages 12–14 in 2002 

would have prevented 267,000 youth from drinking during 2003, 183,000 from using 

marijuana, 138,000 from using cocaine, and 205,000 from using tobacco (see Table 5, 

medium estimates). Prevention programming also would have prevented 169,000 youth from 

binge drinking in 2003, and 72,000 youth from smoking regularly. 

Following Greenwood and colleagues (1996); Miller and Levy (2000); and Aos and 

colleagues (1999), the impact was reduced by 25 percent to account for reduced intervention 

effectiveness as one scales up from demonstration to full nationwide implementation. It is 

assumed that as programs move from the laboratory to full field implementation, some drop 

in effectiveness will occur. 

Table 5: High, Medium, and Low Estimates of the Number of Youth Ages 

12–14 Who Would Avoid Past Month Substance Use, Binge Drinking, and Smoking 

Regularly During 2003 If They Participated in Effective Nationwide School-Based 

7 Prevention Programming in 2002 

Substance Low Estimate Medium Estimate High Estimate

Alcohol Use 57,000 267,000 586,000

Binge Drinking 36,000 169,000 369,000

Marijuana Use 100,000 183,000 359,000

Cocaine Use 103,000 138,000 237,000

Tobacco Use8

89,000 205,000 393,000

Regular Smoking 32,000 72,000 139,000

___________________________________________ 

7

Product of the estimates from Table 4 and ratios from the 2003 YRBS of current to lifetime users by substance, of binge 

drinkers during the past month to lifetime drinkers, and of youth smoking on at least 20 of the past 30 days to lifetime 

smokers. Assumes youth would not also be participating in effective family/community-based prevention programs. Includes 

benefits from youth who actually participated in effective school-based substance abuse prevention programs in 2002. 

8Tobacco use includes smokeless (chewing) tobacco. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

14

Table 6 translates these results into percentage decreases in substance use by youth ages 13–

15 in 2003. All use reported is based on YRBS responses reporting use in the past 30 days. 

The percentage of youth who use cocaine would decline by 45.8 percent.9 In percentages, the 

declines in abuse of other substances are smaller although still substantial. They include a 7.4 

percent decline in alcohol use, an 11.5 percent decline in marijuana use, and an 11.8 percent 

decline in tobacco use. Binge drinking among these youth would drop by 8 percent, and 

regular smoking would drop by 10.7 percent. These reductions would diminish over time. 

Table 6: Number and Percentage of Youth Ages 13–15 Who Were Using and Abusing 

Alcohol, Marijuana, Cocaine, and Tobacco in 2003, United States, and Reduction 

Achievable If All Had Participated in Effective Nationwide School-Based 

10 Prevention Programming in 2002 

Current Behavior Number of Youth 

Using

Number Reduced Percentage 

Reduction

Alcohol Use 3,603,000 267,000 7.4

Binge Drinking 2,104,000 169,000 8.0

Marijuana Use 1,591,000 183,000 11.5

Cocaine Use 301,000 138,000 45.8

Tobacco Use 1,737,000 205,000 11.8

Regular Smoking 674,000 72,000 10.7

4.2. National Cost Savings 

The estimates in this report update the analysis of Caulkins and colleagues (2002) with 

refined program cost estimates and the social cost estimates in Table 4 and Table A5 in the 

Appendix. 

___________________________________________ 

9This estimate may be conservative. It excludes any possible multiplier effect from reduced peer pressure to try cocaine 

associated with a reduction in the number of peers using cocaine or from reduced cocaine availability to youth as a result of a 

substantial drop in demand. 

10Number of youth using is the product of the U.S. population ages 12–17 and usage rates reported in the 2003 YRBS of 

youth ages 14–17. Usage for youth ages 12–13 was inferred from 1996 data from the Health Behaviors of School Children 

survey. 

Effective prevention programs would reduce binge drinking by

8 percent, marijuana use by 11.5 percent, cocaine use by

45.8 percent, and regular smoking by 10.7 percent.
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

15

As shown in Table 7, nationwide school-based prevention program would save an estimated 

range of costs: 

$2.2 to $22.3 billion in monetary costs related to alcohol 

$7.0 to $30.8 billion in monetary costs related to tobacco 

$40.8 to $197.2 billion for all substances and all costs 

Table 7 also shows that the potential national monetary cost savings from implementing 

effective school-based substance abuse prevention programming in 2002 would total between 

$14.4 billion and $67.7 billion, with a best estimate (i.e., medium estimate) of $33.5 billion. 

Of the $33.5 billion, $16.1 billion would result from reduced tobacco use, $10.1 billion from 

reduced alcohol use, $6.7 billion from reduced cocaine use, and $0.6 billion from reduced 

marijuana use. Taking the more controversial step of adding the value of the loss in quality of 

life yields a total cost savings of $98.6 billion. 

The impact of substance abuse prevention may extend over a lifetime and is most obvious 

when prevention fails to deter an individual from substance abuse, and the abuse results in 

premature death. Substance abuse may last many years and often entails periods of recovery 

and relapse. Furthermore, the effects of substance abuse may continue well beyond the 

period of time when an individual is actively abusing substances. 

Table 8 breaks down the potential cost savings by cost category. The following cost factors 

were considered: 

Medical costs 

Other resource costs, ranging from property damage to police, criminal justice, litigation, 

and insurance administration expenses 

Lost wage and household work 

Value of pain, suffering, and loss in quality of life 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

16

Table 7: High, Medium, and Low Estimates of Potential Lifetime Monetary and Total Cost 

Savings to Society From Implementing Effective Nationwide School-Based 

Prevention Programming in 2002 for Youth Ages 12–14, by Type of Substance (in 

11 billions)

Substance Low Estimate Medium Estimate High Estimate

Monetary Costs

Alcohol $2.2 $10.1 $22.3 

Marijuana $0.3 $0.6 $1.0 

Cocaine $4.9 $6.7 $13.6 

Tobacco $7.0 $16.1 $30.8 

Total $14.4 $33.5 $67.7 

Overall Costs

Alcohol $5.5 $25.9 $57.1 

Marijuana $0.6 $1.0 $1.7 

Cocaine $8.4 $11.5 $23.4 

Tobacco $26.3 $60.1 $115.0 

Total $40.8 $98.6 $197.2 

Table 8: High, Medium, and Low Estimates of Potential Total Cost Savings to Society From 

Implementing Nationwide School-Based Prevention Programming in 2002 for 

12 Youth Ages 12–14, by Cost Category (in billions)

Cost Category Low Estimate Medium Estimate High Estimate

Medical $1.5 $4.0 $8.4 

Other Resource $1.6 $3.3 $6.9 

Work Loss $11.3 $26.2 $52.4 

Quality of Life $26.4 $65.1 $129.5 

Total Cost $40.8 $98.6 $197.2 

_______________________________________________ 

11Assumptions: Cost savings accrue over a multiyear period. Future costs were converted to present value using a 3 percent 

discount rate. Costs due to youth substance abuse decline at the same rate as the number of initiators. All assumptions in 

Table 3 apply as well. Estimated substance abuse costs to society were computed with the model described in chapter 5, 

which is adapted from Caulkins et al. (2002). Savings from existing school-based programs are included in these estimates. 

12Assumptions: Cost savings accrue over a multiyear period. Future costs were converted to present value using a 3 percent 

discount rate. Costs due to youth substance abuse decline at the same rate as the number of initiators. All assumptions in 

Table 3 apply as well. Substance abuse costs to society were computed with the model described in chapter 5, which is 

adapted from Caulkins et al. (2002). 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

17

4.2.1. Cost-Benefit Ratios 

To achieve these savings school-based prevention programming would cost an estimated 

$220 per pupil nationwide. This cost represents the average across the 11 school-based 

prevention programs analyzed in this section. Knowledge of program costs makes it possible 

to estimate the cost-benefit measures defined in Section 2. 

The return on investment in school-based prevention services would range between $7.40 

and $36 per dollar invested, with a medium estimate of $18 (see Table 9). The best estimate 

equates to a net saving of $3,740 per youth served, including a $74 net savings in medical 

and other resource costs ($294–$220).

Since expected medical and other resource cost savings exceed program costs, the program 

would yield net cost savings to society. School-based substance abuse prevention 

programming that effectively addresses substance abuse appears to be an excellent 

investment and is likely to pay for itself in resource cost savings alone. 

Table 9: High, Medium, and Low Estimates of Savings Per Pupil, Cost-Benefit Ratio, and 

Net Cost Savings From Implementing Nationwide School-Based Prevention 

Programming in 2002 for Youth Ages 12–1413

Cost Category Low Estimate Medium Estimate High Estimate

a. Total Cost Savings Per 

 Pupil $1,633 $3,960 $7,926

b. Cost-Benefit Ratio 

 (@$220) per pupil $7.40:1 $18.00:1 $36.00:1

c. Net Savings (@$220) 

per pupil $1,413 $3,740 $7,706

_______________________________________________ 

For every dollar spent per pupil, 

society would save $18.

13Costs to State government from NCASA (2001) are summarized in Table 2. State estimates for juvenile justice and 

education were calculated by multiplying the average percentage reduction in drug and alcohol abuse combined, adjusted 

downward by 25 percent for loss in effectiveness through replication, by the CASA study’s estimated costs to State 

governments. Local savings on education were computed from State savings using the 0.87 ratio of local to State 

contributions to elementary and secondary school budgets (U.S. Census Bureau, 2005). 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

18

4.2.2. Cost Savings to States 

The costs of implementing nationwide school-based substance abuse prevention 

programming for youth ages 12–14 in 2002 largely would be marginal costs: the costs of 

diverting teacher and student time from other activities with no increase in teacher salaries or 

costs for facilities. Nevertheless, at $220 per student, the national cost would be almost $2.8 

billion. Of that amount, cost estimates suggest that $670 million ($53 per student) are direct 

costs with additional out-of-pocket expenses for training and materials. The direct costs come 

from State and local government coffers. The net impact on State and local government 

finances is relevant although they generate far larger savings to society (documented in 

Tables 7 and 8). 

This section estimates low, medium, and high estimates of the likely near-term savings 

(within 2 years) to States and localities from the nationwide program. It builds from 

NCASA’s estimates of the cost of substance abuse to States (see Table 2). Among the costs 

NCASA examined, the costs associated almost exclusively with youth substance abuse are 

juvenile justice and education (elementary and secondary). 

NCASA’s cost estimates represent totals for youth ages 12–17. To estimate the portion that 

the nationwide program would prevent, this analysis multiplied NCASA’s estimates by the 

number of initiations of alcohol, marijuana, and cocaine use that would be delayed (see Table 

4) and divided by the number of youth ages 12–17 using alcohol, marijuana, or cocaine in 

2003.14 Because initiation will be delayed for an average of 2 years, estimates of the annual 

cost savings were multiplied by 2 to estimate the aggregate savings, discounting the savings 

in the second year to the present value with a 3 percent discount rate. 

Local near-term savings in education expenditures were computed from State savings by 

applying a ratio of $0.87 in elementary and secondary education funding in 2003 from local 

government for every dollar provided by State government (U.S. Census Bureau, 2005, Table 

1). 

Rather than trying to apportion NCASA’s State health care spending estimates for alcohol 

and drug abuse among age groups, this analysis directly estimated the proportion of 

reductions in medical spending shown in Table 10 that States would pay. To do so, the 

medical cost savings were multiplied by the percentage of national health care expenditures 

paid by Medicaid (16 percent), then by the percentage of Medicaid spending paid by the 

_______________________________________________ 

14.The computation uses the estimate for ages 13–15 from Table 4 with the number of users age 12 computed comparably to 

users age 13, and using 2003 YRBS data, the estimated number of users ages 16–17. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

19

States (41.2 percent) (Office of Research, Development and Information, 2004). This 

estimate includes near-term savings from reduced tobacco use as well as reduced alcohol and 

drug use.15 

Some unknown portion of costs in additional cost categories also results from youth 

substance abuse. For lack of data on the portion of costs associated with youth, the impact of 

cost on the following was omitted: 

Public safety 

Judiciary 

Child/family assistance (child welfare, income assistance) 

Mental health/developmental disabilities 

Table 10 also identifies a portion of near-term savings to State and local governments that 

can be expected from a nationwide school-based prevention program. State and local 

government savings in the first 2 years after implementing nationwide school-based 

substance abuse prevention programming for youth ages 12–14 would exceed the direct 

additional costs for teacher training and program delivery. Indeed, cost savings to the 

education system alone appear likely to exceed direct programs costs. The education system 

would save money by implementing substance abuse prevention programming. 

Table 10: High, Medium, and Low Estimates of Potential Near-Term Cost Savings to State 

and Local Governments From Implementing Effective Nationwide School-Based 

Substance Abuse Prevention Programming in 2002 for Youth Ages 12–14 (in 

millions)16

Cost Category Low Estimate Medium Estimate High Estimate

Juvenile Justice $36 $98 $199 

Education $383 $1,038 $2,119 

Health Services $68 $175 $360 

Total $487 $1,310 $2,678 

_______________________________________________ 

15Tobacco use does not affect juvenile justice and education costs. 

16Costs to State government from NCASA (2001) are summarized in Table 2. State estimates for juvenile justice and 

education were calculated by multiplying the average percentage reduction in drug and alcohol abuse combined, adjusted 

downward by 25 percent for loss in effectiveness through replication, by the CASA study’s estimated costs to State 

governments. Local savings on education were computed from State savings using the 0.87 ratio of local to State 

contributions to elementary and secondary school budgets (U.S. Census Bureau, 2005). 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

20

Effective nationwide school-based substance abuse prevention programming would offer 

State savings within 2 years ranging from:

$36 million to $199 million in juvenile justice 

$383 million to $2.1 billion in education 

$68 million to $360 million in health services 

Figure 2: State Savings Within 2 Years of Implementation of Effective Prevention 

Programs Using Medium Estimates Millions

1

$175

$1,310 

$1,038 

$97 

0

500

1000

1500

Juvenile Justice Education Health Services Total

Categories of Savings

While NSDUH reports that nearly 80 percent of students receive some form of alcohol and 

drug education (SAMHSA, 2004), Flewelling and colleagues (2005) report that schools 

nationwide were only using evidence-based prevention programs about 20 percent of the 

time. 

5.Cost-Benefit Analyses of Specific Policies and Programs 

SAMHSA’s continuum of care suggests some overlap in prevention programs (i.e., universal, 

selected, and indicated).17 For example, when the Strengthening Families Program prevents a 

youth from adopting multirisk behavior, it clearly is prevention. Similarly, when Project 

Northland prevents a youth from ever trying cocaine or delays initiation of cocaine use, it 

unambiguously prevents illicit substance use. Indicated prevention programs can also work to 

prevent an increase or expansion of early experimental substance use behaviors. When the 

topic is preventing the costs of substance abuse, the distinction blurs between programs that 

prevent binge drinking per se and those that prevent costly adverse consequences attributable 

to substance abuse (e.g., programs to prevent drinking and driving). 

This section provides more detail about the cost-benefit ratios of different types of effective 

prevention policies and programs. Nine environmental strategies that create laws and policies 

_____________________________________________ 

17Universal preventive interventions are targeted to the general public or a segment of the entire population with an average 

probability of developing a disorder, risk, or condition. Selected preventive interventions are targeted to specific populations 

whose risk of a disorder is significantly higher than average, either imminently or over a lifetime. Indicated preventive 

interventions are targeted to designated individuals who have minimal but detectable signs or symptoms suggesting a 

disorder or who carry biological markers for a disorder often referred to as high risk. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

21

that limit access are discussed and their cost-benefit ratios listed. The cost-benefit ratios for 

10 prevention interventions that integrate family, community, and school efforts to reduce 

substance abuse are compared, as are 12 programs typically offered by schools. This section 

also presents cost-benefit ratios estimated for programs that specifically target tobacco use. 

Table A1 in the appendix includes cost-benefit ratios for 95 effective prevention programs.

5.1. Environmental Interventions

Nine environmental interventions directly target reducing consumption of alcohol or drugs or 

over-the-limit consumption of alcohol (see Table 11). Most of the proven environmental 

interventions focus on alcohol consumption, which is responsible for 38 percent of all 

substance abuse costs (computed from Table 1). 

The interventions reduce consumption through various means, including raising price, 

inducing servers to discontinue service for patrons experiencing intoxication, imposing a 

driving curfew on youth (along with other provisional driving restrictions), and combining

peer pressure with random testing for illicit drugs or for alcohol use in the workplace. Five of 

these nine interventions offer net cost savings (cost/QALY saved < $0 in Table 11), meaning 

their costs are less than the medical and other resource cost savings they yield.

The provisional licensing and youth driving curfew measure is likely to affect a range of 

risky youth behaviors, but only its impact on motor vehicle crashes has been evaluated. A 

midnight curfew offers a higher return than a 10 p.m. curfew.

Some interventions are well supported; others are quite promising but warrant wider 

evaluation. Raising alcohol excise taxes to 20 percent of the pretax selling price, having a 

minimum legal drinking age of 21, and a curfew for novice drivers are already well 

supported. The highest ratios were for passing and enforcing laws against serving patrons 

who are intoxicated and training servers to recognize impairment. Although very promising, 

these interventions need wider evaluation before moving to national implementation.

In workplaces where substance abuse is endemic, coupling peer support with a program to 

change workplace culture, and providing management support for substance abuse 

rehabilitation and drug and alcohol testing also are quite promising and merit broader 

evaluation.
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

22

Table 11: Cost-Benefit Ratios and Cost/QALY for Nine Environmental Alcohol and Drug 

Use/Abuse Interventions (in 2002 dollars) 

Unit Cost Medical

Other 

Monetary 

18

Quality

of Life

Total 

Benefits 

19

CostBenefit 

Ratio

Cost/

QALY 

Saved

Environmental Interventions 

20 Percent

Alcohol Tax

$9/drinker/

year 20 $4 $30 $50 $84 9.3:1 <$0

30 Percent

Alcohol Tax

$17/drinker/

year 

$5 $38 $66 $110 6.4:1 $6,800

21 Minimum 

Legal 

Drinking Age

$160/youth 

18–20

$34 $190 $360 $590 3.6:1 $18,000

Mandatory 

Server 

Training

$40/driver $9 $56 $95 $160 3.8:1 $16,000

Enforce 

Serving 

Intoxicated 

Patron Law

$.30/driver $3 $10 $13 $25 84:1 <$0

Provisional 

Licensing and 

Midnight 

Driving 

Curfew 

$68/driver $34 $200 $320 $550 8.1:1 <$0

Change 

Driving 

Curfew to

10 p.m.

$130/driver $20 $120 $190 $330 2.6:1 $31,000

Workplace 

Peer Support 

and Drug 

Testing21

$61/

employee $1,500 24:1 <$0

Add Alcohol 

Testing to 

Peer Support

$10/

employee

$628 63:1 <$0

18Monetary costs include direct nonmedical cost savings and indirect work loss savings. Cost/QALY saved = QALYs 

saved/(intervention cost – direct cost savings). 

19Numbers do not correspond exactly to prior columns due to rounding. All numbers were computed, and then rounded. 

20Weimer and Vining (1999) computed cost as the ―deadweight loss‖ or loss in ―consumer surplus‖ as a result of the tax. This 

loss is the difference between the price of a drink without added taxes and the price with taxes that consumers were not 

willing to pay because of added taxes. Miller and Levy (2000) divided the annual national cost from Weimer and Vining by 

the number of drinkers in the United States. 

21Cost savings from this program were evaluated from the employer’s perspective. Social savings would be larger. Source: 

Miller and Levy, 2000; Miller and Hendrie, 2005; Weimer and Vining, 1999. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

23

5.2. Youth-, Family-, and School-Based Programs 

Youth ages 12–17 who abuse substances constitute approximately 11 percent of people who 

engage in binge drinking and 15 percent of people involved in illicit drug use in the United 

States.22 Table 12 reports the return on 22 youth development programs that integrate school, 

family, and community efforts to strengthen family and adolescents and reduce the initiation 

of alcohol, tobacco, and drug use. 

The highest estimated returns may be achieved through Adolescent Transitions, Family 

Mattes, the Good Behavior Game, and Strengthening Families. The Child Development 

Project; Skills, Opportunities, and Recognition (SOAR, previously the Seattle Social 

____________________________ 

22Estimated with online data from the 2003 YRBS and the 2003 NSDUH. 

Figure 3: Savings Per Dollar Spent From Nationwide Implementation of Environmental 

Strategies 

Strategies

This bar chart highlight s the savings for every dollar spent on environmental programs

$63.00

$24.00

$9.30

$8.10

$6.40

$3.80

$3.60

$2.60

$0.00 $10.00 $20.00 $30.00 $40.00 $50.00 $60.00 $70.00

 Add Alcohol Testing

to Peer Support(d)

Workplace Peer Support 

+ Drug Testing (d)

20% Alcohol Tax

Provisional Licensing + 

Midnight Driving Curfew

30% Alcohol Tax

Mandatory 

ServerTraining

21 Minimum Legal 

Drinking Age

 Change Driving 

Curfew to 10 PM

Dollars Saved
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

24

Development Program); and Social Competence Promotion also may offer solid returns on 

investment. Conversely, the proven benefits of CASA Start and Project PATHE appear 

smaller than the costs of these programs, and Across Ages offers a minimal proven return.23

Five of the 10 effective school-based substance abuse prevention programs may yield net 

cost savings to society. The mean return on investment across these interventions is 

calculated to be $15.3:1, with a range from $3.8:1 to $34:1. To some extent, these results 

may be influenced by the sample size in existing evaluations, which may keep reductions in 

substance abuse from achieving statistical significance in some programs. 

Family-centered interventions with a school component generally are more costly than 

school-based life skills training, but they offer larger benefits per youth assisted. The most 

effective programs strengthen youth bonds to family, school, and community, increasing 

protective factors while reducing risk factors. These include Adolescent Transitions, 

Strengthening Families, Guiding Good Choices, Project Northland, and SOAR. 

Although family-centered programs achieve more in terms of bonding and protective factors, 

some narrower life skills programs offer larger returns per dollar invested. With a limited 

budget, life skills programs allow a school system to reach the most children. However, the 

same money probably would yield greater benefits per youth assisted if spent targeting the 

broader family-centered programs and related mentoring to the schools at highest risk. 

_________________________ 

23Miller and Hendrie (2005) followed the model in Spoth et al. (2002) in evaluating the Strengthening Families Program and 

 Preparing for the Drug-Free Years rather than the model used here to evaluate all of the youth substance abuse 

prevention programs. Spoth’s model ignores the likelihood that youth typically are delayed in initiating alcohol use rather than 

prevented from initiating. Therefore, Miller and Hendrie’s cost-benefit estimates were much higher. The estimates here for other 

 youth substance abuse interventions are based on meta-analyses of effectiveness rather than the Caulkins et al. (2002) 

 estimates of effectiveness used by Miller and Hendrie. Some of their intervention cost estimates were refined; therefore, the 

 estimates in this analysis supersede their estimates. 
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

25

Table 12: Cost-Benefit Ratios and Cost/QALY for 22 School-, Family-, or CommunityBased Substance Abuse Prevention Programs (in 2002 dollars) 

Unit Cost Medical

Other 

Monetary 

24

Quality

of Life

Total 

Benefits 

25

BenefitCost 

Ratio

Cost/

QALY 

Saved

Youth Development Through Integrated Family or Community and School Programs

Across Ages $1,750/pupil $210 $780 $1,440 $2,400 1.4 $99,000

Adolescent 

Transitions $1,200/pupil $370 $2,570 $6,570 $9,500 7.8 $10,300

CASA Start $5,650/pupil $370 $1,710 $2,780 $4,900 0.9 $173,000

Child 

Development 

Project

$230/pupil $120 $550 $790 $1,500 6.3 <$0

Family

Matters $160/Family $180 $1,280 $3,300 $4,800 30 <$0

Good Behavior 

Game $61/pupil $32 $540 $1,570 $2,100 35 $1,900

Guiding Good 

Choices (a.k.a. 

PDFY)

$710/family $180 $900 $1,370 $2,500 3.4 $15,000

Project 

PATHE $800/pupil $0 $0 $0 $0 0.0 Infinite

Skills, 

Opportunities 

and Recognition 

(SOAR, a.k.a. 

Seattle Social 

Development 

Program)

$3,200/child $600 $7,600 $11,000 $19,000 5.9 <$0

Social 

Competence 

Promotion

$350/pupil $220 $760 $1,530 $2,500 7.1 $0

Strengthening 

Families $880/family $550 $3,200 $6,100 $10,000 11 <$0

All Stars $140/pupil $185 $1,310 $3,310 $4,810 34 <$0

DARE (original 

program) $100/pupil $0 $0 $0 $0 0.0 Infinite

Keepin’ It Real $130/pupil $230 $1,040 $2,310 $3,600 28 <$0

Life Skills 

Training $220/pupil $110 $1,310 $3,200 $4,600 21 $800

Project Alert $120/pupil $52 $360 $290 $700 6.0 <$0
Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

26

Unit Cost Medical

Other 

Monetary 

24

Quality

of Life

Total 

Benefits 

25

BenefitCost 

Ratio

Cost/

QALY 

Saved

Youth Development Through Integrated Family or Community and School Programs

Project 

Northland $400/pupil $250 $1,990 $4,680 $6,900 17 <$0

Project STAR 

(a.k.a. MPP) $400/pupil $160 $1,330 $2,630 $4,100 10 $2,300

Project TND 

(Toward No 

Drugs)

$180/pupil $50 $350 $290 $690 3.8 $12,600

STARS for 

Families $120/pupil $73 $170 $250 $490 4.0 <$0

Other Social 

Influence/Skills 

Building

$150/pupil $63 $490 $1,270 $1,800 12 $4,600

Other Risk and 

Protective 

Factors

$400/pupil $240 $1,950 $4,720 $6,900 17 $40

_______________________________________________ 

24Monetary costs include direct nonmedical cost savings and indirect work loss savings. Cost/QALY saved = QALYs saved/(intervention cost 

– direct cost savings). 

25 .

Numbers do not exactly correspond to prior columns due to rounding. All numbers were computed, and then rounded Source: Original 

estimates by Miller and Hendrie. 
27

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Figure 4: Cost-Benefit Ratios for Youth Development Through Integrated Family or 

Community and School Programs 

$1.30

$11.00

$0.90

$6.20

$33.00

$3.30

$0.00

$5.90

$6.80

$11.00

$0.00 $5.00 $10.00 $15.00 $20.00 $25.00 $30.00 $35.00

Across Ages

Adolescent Transitions

CASAstart

Child Development Project

Good Behavior Game

Guiding Good Choices (aka PDFY)

Project PATHE

Skills, Opportunities & Recognition (SOAR, aka

Seattle Social Development Program)

Social Competence Promotion

Strengthening Families

Programs

Cost-Benefit Ratios

This bar chart illustrates the dollars that would be saved for every dollar spent.

$1.30

$11.00

$0.90

$6.20

$33.00

$3.30

$0.00

$5.90

$6.80

$11.00

$0.00 $5.00 $10.00 $15.00 $20.00 $25.00 $30.00 $35.00

Across Ages

Adolescent Transitions

CASAstart

Child Development Project

Good Behavior Game

Guiding Good Choices (aka PDFY)

Project PATHE

Skills, Opportunities & Recognition (SOAR, aka

Seattle Social Development Program)

Social Competence Promotion

Strengthening Families

Programs

Cost-Benefit Ratios

This bar chart illustrates the dollars that would be saved for every dollar spent.
28

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

5.3. Programs Exclusively Focused on Tobacco 

Among current smokers, 7.5 percent are youth ages 12–17.26 The four prevention programs 

in Table 13, of which three are school-based, focus on youth tobacco use. The Minnesota 

Smoking Prevention Program and Know Your Body offer larger returns on investment than 

Project TNT (Toward No Tobacco) or a youth antismoking media campaign. Although the 

return on investment in smoking prevention is quite large, much of this return is due to life 

years that will be saved in the distant future. The cost per QALY saved by some of these 

programs is higher than for many of the broader substance abuse prevention programs. 

Table 13: Cost-Benefit Ratios and Cost/QALY for Four School- or Community-Based 

Tobacco Use Prevention Programs (in 2002 dollars) 

Unit Cost Medical

Other 

Monetary 

27

Quality

of Life

Total 

Benefits 

28

BenefitCost 

Ratio

Cost/

QALY 

Saved

Youth Tobacco Use Prevention Programs

Know Your 

Body $140/pupil $90 $1,560 $4,490 $6,100 43 $1,200

MN 

Smoking 

Prevention 

Program

$95/pupil $83 $1,430 $4,130 $5,600 59 $300

Project TNT 

(Toward No 

Tobacco)

$180/pupil $43 $730 $2,120 $2,890 16 $6,600

Youth 

Antismoking 

Mass Media 

Campaign

$370/pupil $57 $980 $2,830 $3,870 10 $11,000

_______________________________________________ 

26Estimated with online data from the 2003 YRBS and 2003 NSDUH. 

27Monetary costs include direct nonmedical cost savings and indirect work loss savings. Cost/QALY saved =QALYs saved/(intervention cost 

– direct cost savings). 

28Numbers do not correspond exactly to prior columns due to rounding. All numbers were computed, and then rounded. Source: Original 

estimates by Miller and Hendrie. 
29

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Figure 5. Cost-Benefit Ratios for School-Based Prevention Programs (in 2002 dollars) 

$17.00

$12.00

$3.80

$3.80

$16.00

$6.10

$19.00

$27.00

$28.00

$10.00

$32.00

$0.00 $5.00 $10.00 $15.00 $20.00 $25.00 $30.00 $35.00

All Stars

Family Matters

Keepin ' It Real

Life Skills Training

Project Alert

Project Northland

Project STAR ( aka MPP)

Project TND (Toward No 

Drugs)

STARS for Families

Other Social Influence/Skills Building

Other Risk & Protective Factors

Programs

$17.00

$12.00

$3.80

$3.80

$16.00

$6.10

$19.00

$27.00

$28.00

$10.00

$32.00

$0.00 $5.00 $10.00 $15.00 $20.00 $25.00 $30.00 $35.00

All Stars

Family Matters

Keepin ' It Real

Life Skills Training

Project Alert

Project Northland

Project STAR ( aka MPP)

Project TND (Toward No 

Drugs)

STARS for Families

Other Social Influence/Skills Building

Other Risk & Protective Factors

This bar chart illustrates the dollars saved for every dollar spent for school based-programs
30

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

6. Policy Implications and Future Directions 

As these findings indicate, the costs of substance abuse to society are significant, and cost 

savings may offset the cost of providing effective prevention. This study’s set of cost-benefit 

analyses will further the prevention field’s ability to justify increases in public support for 

effective prevention funding. This section raises some considerations involved when using 

cost-savings analyses to structure a prevention package. Directions for future analysis are 

suggested. 

6.1 Prevention Program Packages 

Substance abuse has a wide range of adverse consequences. In order to optimally reduce 

consumption and its adverse consequences, a comprehensive package of prevention 

programs and strategies is required. No single intervention will reduce the problem so 

dramatically that no further public action is desirable. Given the number and diversity of 

proven interventions, optimal resource allocation requires selecting the most complementary, 

politically feasible, and culturally and demographically appropriate set to maximize a return 

on investment within the available funding. Of critical concern is to identify a sensible 

package of interventions that complements existing interventions. 

Policymakers selecting substance abuse interventions can apply a series of filters. The 

estimates in this report provide the first filter: eliminating interventions that offer a 

questionable return on investment. However, ―new and improved‖ versions of the original 

DARE program, Here’s Looking At You (Farley & Associates 2002) and the Adolescent 

Substance Abuse Prevention Study (Sloboda & Hawthorne, 2003) have produced better 

results and consequently better cost-benefit ratios and should not be dismissed arbitrarily. 

This financial information should be used as only one of an array of measures in selecting 

effective programs. 

Additional filters that policymakers can use in selecting interventions are political feasibility, 

local priorities, appropriateness for the target population, cultural sensitivity, affordability, 

and the immediacy of the impact (weeks versus years). Political feasibility is especially 

important. A slightly less cost-beneficial program can be superior if the alternative with the 

higher return has a lower chance of widespread implementation or involves a long delay in 

implementation. As the subsections that follow describe, all things are not equal when 

selecting a package that yields the maximum gains at the lowest possible price. Other factors, 

such as aggregate benefits obtained, overlapping effects, spillover costs and benefits, and 

government cost can and should weigh into the decision process. 

6.1.1. Decisionmaking Based on Aggregate Benefits 

When evaluating alternatives in a resource-constrained world, the highest cost-benefit ratio 

may not always be the best choice. Another program alternative may yield larger benefits, 

but at a slightly higher cost per unit of safety. Choosing interventions to address a problem 
31

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

requires weighing the overall impact of the problem and the benefits per dollar invested. For 

example, zero alcohol tolerance for youth and child safety seat laws has much higher costbenefit ratios than sobriety checkpoints, regional trauma systems, alcohol taxes, and airbags.

But drivers under 21 account for only 18 percent of alcohol-impaired driving deaths in the 

United States, young child occupants 1 percent, motorcyclists 7 percent, and hardcore 

recidivists 10 percent. Interventions targeted on these groups leave 64 percent of the problem 

untouched. Less cost-effective interventions address broader aspects of the problem and can 

prevent many more impaired driving deaths.

In contrast, Table A1 in the appendix, shows that the largest return on investments in public 

interventions to reduce impaired driving or its adverse consequences occurs from laws 

mandating child passenger protection, child bicycle helmet use, and zero alcohol tolerance 

for drivers below the legal drinking age. In a resource-constrained economy, the greatest 

reduction in the aggregate might occur from interventions that do not overlap and have high 

returns—not those with the greatest impact in the aggregate on the problem.

6.1.2. Intervention Overlap 

No single intervention has been demonstrated to reduce the problem of alcohol-impaired 

driving by more than 17 percent. Therefore, a far more important concern than the best single 

intervention to implement is the best package of interventions to apply. Understanding how 

interventions overlap is key to selecting that package. 

Interventions that largely address different aspects of the problem are good candidates for 

combined implementation. For example, if one intervention reduces the risk of drivers below 

the minimum legal drinking age, while a second reduces the risk of hardcore repeat offenders 

whose licenses previously were revoked due to impaired driving, implementing both together 

will yield the full benefits that both have to offer. But if provisional licensing with a midnight 

curfew for new drivers offers an 11 percent reduction in substance-related crashes in this age 

group, and zero tolerance for alcohol for drivers below the legal minimum drinking age 

offers a 40 percent reduction, the two interventions combined may offer only a 46.6 percent 

reduction (40% + 11%) (100% – 40%) among young drivers. 

6.2 Future Directions

Clearly, the ability to conduct cost-outcome analyses of substance abuse prevention efforts 

has improved. Although this report evaluated a wide range of interventions, it was 

challenging because of the difficulties in determining program costs. It was often unclear 

how many youth would be targeted, and estimates of some costs were not readily available 

(methamphetamine use, club drug use, and college drinking). These difficulties prevented an 

accurate analysis of the return on investment in programs targeting those behaviors. In the

future, evaluative research priorities may include (1) tracking long-term outcomes beyond a 

2-year period, (2) examining the impact of delaying initiation on the seriousness and 

consequences of future use, (3) performing replications to refine estimates of effectiveness 

from youth interventions that presently have been evaluated with only a single randomized 
32

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

controlled trial, and (4) developing, implementing, and reporting on interventions that drive 

costs. 

7. Conclusion 

If effective prevention programs were implemented nationwide, substance abuse initiation 

would decline for 1.5 million youth and be delayed for 2 years on average. In 2003, an 

estimated: 

8 percent fewer youth ages 13–15 would not have engaged in binge drinking 

11.5 percent fewer youth would not have used marijuana 

45.8 percent fewer youth would not have used cocaine 

10.7 percent fewer youth would not have smoked regularly 

The average effective school-based program costs $220 per pupil. It would save an estimated 

$18 per $1 invested if implemented nationwide. Nationwide school-based effective 

programming in 2002 would have had the following fiscal impact: 

Saved State and local governments $1.3 billion, including $1.05 billion in educational 

costs during 2003 and 2004 

Reduced social costs of substance-abuse–related medical care, other resources, and lost 

productivity over a lifetime by an estimated $33.5 billion 

Preserved the quality of life over a lifetime valued at $65 billion 

These cost-benefit estimates show that effective school-based programs pay for themselves 

and more. For every dollar spent on these programs, an average of $18 dollars per student 

would be saved over their lifetime. 

Among 10 effective school-based life skills programs, the average return on investment 

exceeded $15 to 1. That is, every dollar spent on these programs returned an average of $15 

dollars per student. The probable costs and cost savings involved in implementing a 

composite of these programs for middle school youth ages 12–14 nationwide were estimated. 

The average program would delay more than a million initiations of alcohol, cocaine, 

marijuana, or tobacco use by youth for an average of 2 years. Its cost would be $220 per 

pupil.29

The out-of-pocket expenses would be repaid by savings to the education system alone in less 

than 2 years. The program would offer additional savings to State and local governments by 

reducing spending on Medicaid, police, and other criminal justice services. School-based 

___________________________ 

29Added expenses for program materials and teacher training would average $53 per pupil with the value of teacher time 

diverted from other instruction accounting for the remaining cost. 
33

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

programs that offer a particularly large return on investment include All Stars, Family 

Matters, Keepin’ It Real, Life Skills Training, and Project Northland. Although Project TND 

and STARS for Families yielded lesser returns than competing NREPP programs, they still 

yielded $4 in savings per $1 invested. 

Programs designed to strengthen families generally cost more than the school-based life 

skills programs. Several of them also were highly cost-beneficial and offered much larger 

returns in the aggregate per youth served than the school-based life skills programs. 

In a program targeting families with low income, intensive home visitation, coupled with 

preschool enrichment, reduced infant/toddler abuse (Aos et al., 1999; Karoly et al., 1998). As 

these toddlers reach adolescence and adulthood, visitation programs also can reduce a range 

of problems including substance abuse and violence. However, the net returns are often 

realized in the long term (for actual longitudinal cost-benefit results see Karoly, et al., 1998; 

Schweinhart, et al., 1993).

The proven interventions often cover different aspects of the problem (such as youth drug use 

initiation, impaired driving, and violence), which make a complementary set of interventions 

more beneficial. Several interventions are best directed toward different aspects of the 

problem. If they are massed against the same aspect, the size of that aspect will shrink, and 

the return on added interventions will decline below the levels shown in this study. 

Taken as a whole, the benefits of substance abuse prevention well outweigh the costs of 

providing that service. Cost-benefit ratios can guide the selection of an optimal intervention 

package within the available resources. Political feasibility, cultural and demographic 

differences, and local priorities also must be considered. 
34

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

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Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

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39

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

9. Appendix: Methods 

This section explains how published benefit-cost ratios estimates were adjusted for 86 youth 

development or youth substance abuse prevention programs and related strategies (see Table 

A1). Program costs for the youth programs occasionally came from the literature, but for this 

report, they were usually modeled largely from educational statistics and CSAP summaries 

of costs for training and materials and teacher time requirements (Western Center for the 

Application of Prevention Technologies [Western CAPT], 2005), or similar summaries from 

Maryland Blueprints (Maryland Governor’s Office of Crime Control and Prevention [MD 

GOCCP], 2005). Estimates of program effectiveness were derived from three meta-analyses 

(Aos et al., 2004; Hansen et al., 2004; Hopkins et al., 2001). Table A2 lists the estimates used 

and their sources. 

All individually targeted substance abuse prevention programs with available estimates of 

effectiveness in Aos and colleagues’ 2004 study were analyzed, as were the subset from 

Hansen and associates’ 2004 study. The estimates applied a modified version of the benefits 

valuation model in Caulkins et al. (2002) as refined by Miller and Hendrie (2005). It further 

adjusted the model for consistency with the methods used in the existing cost-savings 

analyses and used effect sizes from the meta-analysis as inputs in place of the estimates of 

effectiveness in percentages used by Caulkins and colleagues (2002). The remainder of this 

appendix lists the major assumptions and discusses the cost-benefit estimation processes. 

9.1 Assumptions 

This report made the following assumptions: 

Estimates of effectiveness from Table 4 apply to U.S. youth ages 12–14 

(9.483 million). 

The impact was reduced by 25 percent to account for reduced intervention effectiveness 

as one scales up from controlled demonstrations to full field implementation 

(Aos et al., 1999; Greenwood et al., 1996; Miller & Levy, 2000). 

Youth would not be participating in effective family/community-based prevention 

programs. 

Benefits apply to youth who actually participated in effective school-based substance 

abuse prevention programs in 2002. 

Costs or benefits were determined by estimates from Table 4, and ratios from the 2003 

YRBS of (1) current to lifetime users by substance, (2) binge drinkers during the past 

month to lifetime drinkers, and (3) youth smoking on at least 20 of the past 30 days to 

lifetime. 

Substance abuse costs decline in proportion to delays in initiation as a result of 

prevention programming. 
40

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Total costs equal the monetary costs plus the value of pain, suffering, and loss in quality 

of life. Estimates are the product of the costs in Table 1 and the percentages in Table 3. 

Benefits accrue over a multiyear period, and future costs can be converted to present 

value using a 3 percent discount rate. 

Costs from substance abuse among youth decline at the same rate as the number of those 

who initiate abuse. 

Savings from existing school-based programs are included in these estimates. 

9.2 Cost Estimation 

Program costs include materials costs, training costs, and labor costs to deliver the 

intervention. Because costs rarely are fully documented, estimating them was the most 

difficult analytic step. Moreover, some estimates are approximations of the order of 

magnitude. 

Training costs are included to comply with accepted cost-outcome analysis guidelines (Gold 

et al., 1996; Haddix et al., 2003). Without teacher training, school-based prevention 

programming cannot be delivered with fidelity and is unlikely to be fully effective. Many 

prevention programs will not sell their materials to schools unless their teachers have been 

trained in the proper use of the materials. Therefore, training costs (including travel to 

training) are an essential element of the costs of prevention programs. 

Where studies of all three cost components (materials, training, and labor) existed, their 

estimates were used. Estimates for three programs (CASA Start, Family Matters, and 

DARE), came from Aos et al. (2004). Spoth et al. (2002) provided detailed cost studies for 

Strengthening Families and Guiding Good Decisions, the two that were more comprehensive. 

The mean cost of $800/pupil from these two programs was applied to two other programs, 

which are broad in scope (school, community, and often media components): Adolescent 

Transitions and Project PATHE. This report used the mean cost of Project Northland and 

Project STAR for a generic risk and protective factors program and the mean cost from the 

six skills-building programs for a generic skills-building program. Cost estimates were 

inflated to 2002 dollars using the Consumer Price Index (CPI). 

The remaining 12 interventions are school-based, and their estimates were based on materials 

costs from the Western CAPT Web site (Western CAPT, 2005) when available, from 

Maryland Blueprints (MD GOCCP, 2005), or from Aos et al. (2004). Where materials costs 

were given per teacher, costs per pupil were computed by dividing by class size (see Table 

A3, item 9). For example, materials for Project Toward No Drugs cost $10/pupil for student 

workbooks, plus $105 for class-level materials that serve an average of 23.6 high school 

students (National Center for Education Statistics [NCES], 2003), adding $4.45 per student 

($105/23.6) to the materials cost. 
41

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

To estimate labor and training costs, the value of teacher time was computed. Table A4 

shows the calculations, which are built primarily from NCES data. Instruction hours by 

program came from the Western CAPT Web site, supplemented as needed with Internet 

searches of the Maryland Blueprints Web site (MD GOCCP, 2005), and individual program 

Web sites. Labor costs beyond the first year of the program were discounted to the present 

value with the 3 percent discount rate recommended by the Panel on Cost-Effectiveness in 

Health and Medicine (Gold et al., 1996). 

Training costs were estimated from the training cost and time information on the Western 

CAPT (2005) and Maryland Blueprint Web sites (MD GOCCP, 2005), plus teacher cost 

estimates. This report assumed that travel to training sessions cost an average of $500, 

including airfare and airport transfers; per diem was $150 per day. For example, 1-day 

teacher training on All Stars would cost the following: (1) $250 registration fee, (2) $500 

travel, (3) $150 per diem, and (4) one day of trainee time at $650 per day. These costs are 

spread over 23.6 students, yielding an estimated training cost of $65 per pupil ($1,550/23.6). 

When program developers trained a trainer, who in turn trained other teachers, this report 

assumed that the local trainer would train 12 teachers in a 1-day session. These estimates are 

higher than would be incurred if trainers traveled to be with teachers. Table A4 summarizes 

the estimates per pupil of trainer fees and travel costs for training, materials costs, and 

teacher salaries including fringe benefits and overhead (for training and separately for 

preparation and classroom delivery.) 
42

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Table A1: Reviewed Studies, Intervention Descriptions, Recomputations, and Quality 

Ratings30

Authors, 

Year 

Published Description

Recomputed 

Cost Savings

Other 

Mod

Demo 

Adj Rating

Substance Use/Abuse Interventions

Environmental Interventions

Miller and 

Levy, 2000

Alcohol tax of 20% of the 

pretax retail price

Yes No No C

Miller and 

Levy, 2000

Alcohol tax of 30% of the 

pretax retail price

Yes No No C

Miller, 2001 21 minimum legal drinking age No No No A

Miller, 2001 Mandatory server training to 

recognize intoxication, cut-off 

service

No Yes Yes C

Miller and 

Levy, 2000

Enforcing laws against serving 

intoxicated patrons of bars and 

restaurants (SIP laws)

No No Yes B

______________________ 

30Table A1 displays the sources for the 35 cost-savings estimates and briefly describes the 35 interventions. Most of the estimates come 

from Aos et al. (1999), Miller and Levy (2000), and Miller and Hendrie (2005). The columns provide the following information. 

―Authors, Year Published‖ provide a brief citation for each analysis. (Full citations are available in the reference list.) ―Description‖ 

briefly states the nature of each intervention analyzed, often providing a more detailed explanation that appears in subsequent tables that 

summarize the cost-savings estimates. ―Recomputed Cost Savings‖ indicate whether the authors, Miller and Levy (2000) or Miller and 

Hendrie (2005) replaced the cost saving with uniformly computed benefits estimates. ―Other Mod.‖ indicates whether the authors Miller 

and Levy (2000) or Miller and Hendrie (2005) made other modifications in the cost-benefit computation besides substituting uniform 

benefit estimates (e.g., recomputing program costs to capture omitted elements like teacher time, switching discount rates or values of 

travel time to uniform values, or updating injury incidence rates). ―Demo Adj.‖ indicates whether the estimate of effectiveness for the 

intervention came from an intervention in the demonstration stage of development. In Aos et al. (1999, 2004), Miller and Levy (2000), 

and Caulkins et al. (2002), the estimates of effectiveness were arbitrarily adjusted downward for all demonstrations because some 

effectiveness would probably be lost in replication/scale-up. The percentage reduction applied was 25 percent. ―Rating‖ provides a 

judgmental estimate of general study quality. This rating came from Miller and Levy (2000) for studies it included. It primarily focuses 

on the strength of the estimate of effectiveness. ―A‖ ratings were assigned to randomized controlled trials without serious attrition 

problems and to interventions that were implemented at a large scale and evaluated with cross-sectional time series or other designs that 

included a credible comparison group. Rating levels declined as the quality of the evidence of effectiveness declined, based largely on 

the design hierarchy and review criteria in Zaza et al. (2000). Ratings also were reduced when benefit valuations were hamper ed by lack 

of quality data. 
43

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Miller and 

Levy, 2000

Provisional licensing of new, 

typically young drivers with a 

midnight curfew until 6 months 

of driving without crash or 

violation

No Yes No B

Miller and 

Levy, 2000

Change youth driving curfew 

from midnight to 10 p.m. until 

6 months driving without crash 

or violation

No Yes No B

Miller et al., 

2005, under 

review

Workplace peer support and 

drug testing 

No No Yes C

Miller et al., 

2005, under 

review

Add alcohol testing to peer 

support

No No Yes C

Youth Development Through Integrated Family or Community and School Programs

Hansen et al., 

2004, 

effectiveness

Across Ages, strengthen adult 

and youth bonds through 

mentoring, community service, 

family activities, ages 9–13

Original est. Yes A

Aos et al., 

2004, 

effectiveness

Adolescent Transitions, 

parenting skills combined with 

universal, indicated, and 

selective prevention, middle 

and high school

Original est. Yes A

Aos et al., 

2004, 

effectiveness

CASA Start, case management, 

after-school, and law 

enforcement efforts selectively 

targeting multirisk youth ages 

8–13

Original est. Yes B+

Aos et al., 

2004, 

effectiveness

Child Development Project, 

build sense of school 

community, grades 3–6

Original est. Yes C

Aos et al., 

2004, 

effectiveness

Good Behavior Game, 

classroom management 

strategy to reduce 

aggression/disruption, grades 

1–3

Original est. Yes B

Spoth et al., 

2002

Guiding Good Choices, parentchild behavioral training, ages 

12–13, aka, Preparing for the 

Drug-Free Years

Yes Yes Yes A
44

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Aos et al., 

2004, 

effectiveness

Project PATHE (Positive 

Action Thru Holistic 

Education), secondary school 

organizational change

Original est. Yes Yes B

Aos et al., 

1999

Skills, Opportunities and 

Recognition (SOAR a.k.a. 

Seattle Social Development 

Program), parent/teacher social 

development training to 

promote bonding, ages 6–11, in 

high crime areas

Original est. Yes BHansen et al., 

2004, 

effectiveness

Social Competence Promotion, 

grades 5–7

Original est. Yes C

Spoth et al., 

2002

Strengthening Families 

Program, parent-child 

behavioral training, ages 12–13

Yes Yes Yes A

School-Based Life Skills

Hansen et al., 

2004 

effectiveness, 

original est.

All Stars, middle school, ages 

11–14

Original est. Yes BEnnett et al., 

1994 

effectiveness; 

Aos et al., 

2004, cost

Drug Abuse Resistance 

Education (DARE), police 

speakers at school assemblies

Original est. No A

Aos et al., 

2004, 

effectiveness

Family Matters, family-focused 

tobacco and alcohol, ages

12–14

Original est. Yes B

Hansen et al., 

2004 

effectiveness, 

original est.

Keepin’ It Real, videoenhanced, culturally grounded, 

2-year communications and life 

skills program, ages 10–17

Original est. Yes C

Hansen et al., 

2004 

effectiveness, 

original est.

Life Skills Training, 3-year 

program, ages 13–16

Yes Yes Yes A

Aos et al., 

2004, 

effectiveness

Project Alert (Adolescent 

Learning Experiences in 

Resistance Training), schoolbased life skills, alcohol and 

drug 2-year program, ages

13–15

Yes Yes Yes C
45

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Aos et al., 

2004, 

effectiveness

Project Northland, schoolbased child-parent training, 3-

year program, ages 12–15

Yes Yes Yes B

Aos et al., 

2004, 

effectiveness

Project STAR, 

school/family/community/

media, 2-year program, ages 

12–15, a.k.a. Midwest 

Prevention Project

Yes Yes Yes B

Aos et al., 

2004, 

effectiveness

Project TND (Toward No 

Drugs), high school

Original est. Yes B

Aos et al., 

2004, 

effectiveness

STARS for Families (Start 

Taking Alcohol Risks 

Seriously), health promotion by 

nurses, 2-year program, middle 

school 

Original est. Yes B

Aos et al., 

2004, 

effectiveness

Other social influence/skills 

building

Original est. Yes B

Aos et al., 

2004, 

effectiveness

Other risk and protective 

factors

Original est. Yes B

Youth Tobacco Use Prevention Programs

Aos et al., 

2004, 

effectiveness

Know Your Body, smoking 

prevention program, grades

K–6

Original est. Yes C

Aos et al., 

2004, 

effectiveness

Minnesota Smoking Prevention 

Program, grades 4–8

Original est. Yes C

Aos et al., 

2004, 

effectiveness

Project TNT (Toward No 

Tobacco), 2-year program, 

middle school

Original est. Yes C

Hopkins et 

al., 2001

Mass media campaign to 

reduce youth smoking initiation

Yes No No A9.3 Benefits Estimation 

Caulkins and colleagues (2002) developed a model for estimating the benefits of reduced 

youth initiation of alcohol, tobacco, marijuana, and drug use. Miller and Hendrie’s (2005) 

modifications were as follows: 

1. Drop Caulkins’ social and market multipliers for cocaine to be conservative because 

Caulkins indicated the empirical basis for these estimates was ―very uncertain‖ and might 

be close to 1.0. 

 
46

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

2. Shift from a 40-percent reduction in effectiveness for demonstrations to the 25 percent 

reduction used throughout the estimates by Aos et al. (1999), Greenwood et al. (1996), 

and Miller and Levy (2000). Without this shift, the estimates could not have been 

compared with those for other interventions. 

3. Add quality-of-life costs to comply with the mandate in OMB (2003) and the guidelines 

in Mishan (1988) and French et al. (1996), among many others. Distribute the economic 

costs into cost categories using the cost distributions by problem in Table A5, so the costs 

could be displayed in the same format as the other cost-savings analyses. 

4. Inflate to 2002 dollars using the CPI, all items, medical spending per capita, and the 

Employment Cost Index – Total Compensation as price adjusters. For consistency with 

the rest of the cost-savings estimates, a causation/correlation multiplier of 0.9 was 

dropped as used by Caulkins et al., (2002). The procedures for estimating effectiveness 

from the meta-analyses also dictated removing another multiplier from the Caulkins et al. 

(2002) model: the percentage of the population using each substance. This factor was 

accounted for in the estimates of effectiveness that were derived. 

A chain of computations was used to estimate the absolute percentage reduction in substance 

abuse from the meta-analysis data (see Table A6). The meta-analyses that supplied estimates 

of effectiveness show the effect size, which was converted to another common meta-analysis 

measure, the binomial effect size display (BESD), which shows the correlation between 

substance abuse outcomes and membership in the treatment versus the control group 

(Rosenthal & DiMatteo, 2001). 

Following Lipsey and Derzon (1998), and Derzon and Lipsey (1999), BESD was used to 

construct a two-by-two contingency table based on the assumption that the treatment and 

control groups were of equal size. This computation used data from Caulkins et al. (2002) on 

the percentage of youth who would abuse the substance of relevance absent intervention. 

Finally, a formula from Falk and Well (1997) was applied to extract the percentage of all 

program participants who would reduce their substance abuse or forego initiation because of 

the program. 

Two interventions, Guiding Good Choices and CASA Start, reduced violence as well as 

substance abuse. To value the reductions in crime, the cost of a youth’s violent crime career 

was used. This cost was determined by multiplying the percentage reduction in violence by 

the probability a youth exposed to the program would become a violent criminal, and a factor 

of 17 percent to account for the likelihood that most potentially violent youth would 

experience a delay in becoming violent but eventually would do so. (The latter factor is used 

in Caulkins et al. [1999, 2002], and the choice of 17 percent was typical of the range of 

values that Caulkins derives.) 

Guiding Good Choices is a universal program, so the exposure probability can be computed 

as 560,359 youth ages 12–20 committing violent crimes in 1999 (spreadsheets supporting 
47

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Biglan et al., 2004), divided by 35.26 million U.S. youth ages 12–20 (U.S. Census Bureau, 

2002). CASA Start is an indicated program targeted to multirisk youth. For this program, the 

probability is determined by dividing 560,359 by 35.26 million youth multiplied by 44.1 

percent multirisk (Miller & Taylor, 2005). 

Table A2: Percentage of Participants Delaying Initiation or Reducing Alcohol, Marijuana, 

Cocaine, and Tobacco Use and a Meta-Analytic Estimate of the Source of 

31 Effectiveness for School and Family/Community-Based Prevention Programs 

Program Alcohol Marijuana Drugs Tobacco Source

Youth Development Programs

Across Ages 9.9% -12.9% 1.9% Hansen et al., 2004

Adolescent Transitions 14.4% 12.0% Aos et al., 2004

CASA Start 12.4% 8.6% Aos et al., 2004

Child Development Project 4.5% 4.1% 3.1% 0.0% Aos et al., 2004

Family Matters 6.9% 6.1% Aos et al., 2004

Good Behavior Game 4.9% Aos et al., 2004

Guiding Good Choices 8.2% 8.9% 0.0% 0.0% Aos et al., 2004; 

Hansen et al., 2004

Project PATHE -5.3% Aos et al., 2004

Skills, Opportunities, and 

Recognition (SOAR)

8.4% 2.4% 0.4% Aos et al., 2004

Social Competence 

Promotion

11.3% Hansen et al., 2004

Strengthening Families 18.0% 15.4% 10.3% 7.3% Aos et al., 2004

_______________ 

31All effects shown are significant at the 90 percent confidence level or greater. Negative numbers mean that intervention 

participants increased use or demonstrated more substance use than those in the comparison group. Blank cells indicate no 

significant effect at the 90 percent confidence level, or that the impact of the intervention on this outcome was not tested, in 

which case the analysis assumed it had no effect. Guiding Good Choices and SOAR also reduce violence. SOAR improves 

school outcomes. 
48

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Program Alcohol Marijuana Drugs Tobacco Source

Youth Substance Abuse Prevention Programs

All Stars

7.0% 6.4% 0.0% 6.0% Hansen et al., 

2004

DARE 0.0% 0.0% 0.0% 0.0% Aos et al., 2004

Keepin’ It Real

10.9% 4.9% 2.1% Hansen et al., 

2004

Life Skills Training 1.0% 3.4% 2.7% 7.4%

Hansen et al., 

2004; Aos et al., 

2004

Project Alert 0.0% 3.6% 3.7% 0.0% Aos et al., 2004

Project Northland 6.9% 6.6% 3.3% 9.0% Aos et al., 2004

Project STAR 2.9% 7.1% 5.2% 4.8% Aos et al., 2004

Project Toward No 

Drugs 

0.0% 0.0% 3.9% 0.0% Aos et al., 2004

STARS for Families 8.3% Aos et al., 2004

Other Social 

Influence/Skills Building

2.5% 1.9% 0.0% 2.7% Aos et al., 2004

Other Risk and 

Protective Factors

7.1% 3.4% 2.3% 9.3% Aos et al., 2004

Youth Tobacco Use Prevention Programs

Know Your Body N/A N/A N/A 13.9% Aos et al., 2004

MN Smoking Prevention 

Program

N/A N/A N/A 10.7% Aos et al., 2004

Project Toward No 

Tobacco

N/A N/A N/A 5.5% Aos et al., 2004

Youth Antismoking 

Mass Media Campaign

N/A N/A N/A 5.5% Hopkins et al., 

2001
49

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Table A3: Teacher Cost Estimates and Their Sources 

Factor

Primary 

(grades 1–6)

Secondary 

(grades 7–12) Source

1. Annual teacher salary (in 2001 dollars) $44,604 $44,604 NCES, 2003

2. Instruction days/year 180 180 Tomlinson, 2004

3. Salary/instruction day $247.80 $247.80 Computed 

item 1/item 2

4. Ratio of salary plus fringe benefits to 

 salary

1.2494 1.2494 NCES, 2003

5. Ratio of total school spending to 

 instructional salary and fringe benefits

2.0528 2.0528 NCES, 2003

6. Loaded salary per instruction day $635.55 $635.55 Computed

item 332, item 433, 

item 5

7. Price adjuster to 2002 from 2001 1.0228 1.0228 Employment 

Cost Index, Total 

Compensation

8. Loaded salary per instruction day

 (in 2002 dollars)

$650.03 $650.03 Computed

item 634, item 7

9. Pupils/class 21.1 23.6 NCES, 2003

10. Cost per pupil day $30.81 $27.54 Computed

item 8/item 9

11. Instruction hours/day 5.5 5.5 Mode of several 

State Web sites

12. Cost per pupil hour $5.60 $5.01 Computed item 

10/item 11

32Assumes that average teacher salaries and overheads are the same for primary and secondary schools. 

33Assumes that average teacher salaries and overheads are the same for primary and secondary schools. 

34Assumes that average teacher salaries and overheads are the same for primary and secondary schools. 
50

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis 

Table A4: Estimated Program Costs by Component (in 2002 dollars) 

Program

Trainer 

and Travel 

for 

Training Materials

Teacher 

Time for 

Training

Teacher 

Time for 

Delivery Total

Youth Development Programs

Adolescent Transitions $83 $12 $83 $1,038 $1,216

Child Development Project $24 $16 $124 $67 $231

Good Behavior Game $34 $0 $28 $0 $62

Social Competence Promotion $0 $4 $124 $226 $354

Average $35 $8 $90 $333 $466

Youth Substance Abuse Prevention Programs

All Stars $38 $5 $28 $70 $141

Keepin’ It Real $14 $5 $55 $55 $129

Life Skills Training $36 $13 $28 $147 $224

Project Alert $34 $0 $28 $55 $117

Project Northland $51 $32 $83 $234 $400

Project Toward No Drugs 

(TND) $78 $14 $28 $61 $181

STARS for Families $36 $9 $0 $77 $122

Average $41 $11 $36 $100 $188

Youth Tobacco Use Prevention Programs

Know Your Body (Smoking) $3 $0 $68 $72 $143

MN Smoking Prevention 

Program $9 $1 $55 $30 $95

Project Toward No Tobacco 

(TNT) $78 $14 $28 $60 $180

Average $30 $5 $50 $54 $139
51

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis March 6, 2007

TABLE A5. Updated Estimates of the Societal Costs of Alcohol and Illicit Drug Abuse That Include Lost Quality of Life and Costs 

to Victims, United States, 2000 (in millions of 2002 dollars)35,36

Medical Other 

Resource

Work Quality of 

Life

Total Medical Other 

Resource

Work Quality of 

Life

Total

Violent Crime 3,396 13,126 13,757 67,664 97,943 885 4,740 11,674 20,260 37,559

Property Crime 3 1,384 2,998 62 4,437 32 10,872 3,760 413 15,077

Public Order/Supply - 1,219 133 - 1,352 - 16,266 22,880 - 39,146

Impaired Driving 6,354 15,195 24,845 54,464 100,858 - - - - -

Other Injury 12,514 1,528 18,815 124,605 157,462 - - - - -

Illness & Poisoning 26,589 504 79,208 100,392 225,288 15,709 252 44,902 74,232 135,095

Total 48,856 32,956 139,746 347,187 568,745 16,626 32,130 83,216 94,905 226,877

____________________ 

35Assumptions: Excludes $9.9 billion in earnings lost to incarceration for alcohol-attributable crime and $58.6 billion in earnings lost to incarceration and criminal careers for drug-attributable crime. Estimates of 

these omitted costs are from Exhibit 2. Unlike in Exhibit 2, work includes the value of lost housework. The value of lost housework came from Haddix et al., (2003). It is based on a survey of how much time 

people spend on different household tasks (by age group and sex) and wage rates from those tasks from the U.S. Department of Labor. Future costs are discounted to present value using a 3% discount rate. 

36Source: Miller and Hendrie (2005), with illness and poisoning costs from Harwood (2000). Uses Bury-Maynard’s (1999) survey-based estimates that average quality of life loss for alcohol abusers is 23.4% and 

for drug abusers is 30.5%. Kraemer et al., (2005) obtains a consistent survey-based estimate that the quality of life loss for an alcohol abuser relative to a non-drinker averages 18%-25%, while Murray and Lopez 

(1996) synthesize an 18% estimate.
52

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis March 6, 2007

Table A6: Factors That Are Multiplied Together To Calculate the Social Benefit From 

Reduction in Substance Use Over a Lifetime37

Factor Source

Lifetime Substance Use Per Person in the Absence of Prevention

1. Use per initiate in the absence of prevention Caulkins et al., 2002

2. Proportion of cohort who would initiate in 

the absence of prevention

Caulkins et al., 2002

3. Discount factor (at 3%) Caulkins et al., 2002

Percentage Reduction in Lifetime Use Expected From Prevention

4. Percentage reduction in initiation observed 

at the end of the prevention program

Computed from meta-analyses and factor 2

5. Percentage reduction in lifetime use per unit 

reduction in initiation at the end of the 

prevention program

Caulkins et al., 2002

Adjustments to Reduction in Use

6. Scale-up qualifier 75% (25% reduction)

Social Cost Per Unit of Use

7. Social cost per unit of use Social costs from Tables 3 and 11

divided by units of use from Caulkins et al., 

2002

____________________ 

37Source: Adopted from Caulkins et al., 2002. 
53

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis March 6, 2007

9.4 Contributing Authors and Reviewers 

Contributing Authors 

Ted R. Miller, Ph.D. 

Director, Public Services Research Institute 

Pacific Institute for Research and Evaluation 

Delia Hendrie, M.A. 

Lecturer 

University of Western Australia 

 

Reviewers 

Adela de la Torre, Ph.D. 

Director and Professor of Chicana/o Studies 

University of California, Davis 

John Carnevale, Ph.D. 

President 

Carnevale Associates 

Jon Caulkins, Ph.D. 

Carnegie Mellon University 

Beverlie Fallik, Ph.D. 

SAMHSA CSAP 

Nancy Kennedy, Ph.D. 

SAMHSA CSAP 

David Shavel, Ph.D. 

The CDM Group, Inc. 

David Tilley, Ph.D. 

Constella Group, LLC 

Virginia Mulkern, Ph.D. 

Vice President 

Health Services Research Institute 

Brian Yates, Ph.D. 

American University 
DHHS Publication No. (SMA) 07-4298

Printed 2008.