A Low-Cost RCT for Evaluating the Impact of a Universal Substance Abuse Prevention Model on the Medicaid System

Duration: 2016 - 2019
Funding: Laura and John Arnold Foundation
Principal Investigator: Max Crowley

young adults


An estimated 75% of all high school students have experimented with drugs and over 12% meet the diagnostic criteria for addiction. Early experimentation (e.g., pre-high school) or early onset of substance abuse (e.g. before 12th grade) predicts a higher risk of subsequent lifetime abuse.

The human and economic costs due to the high prevalence of substance abuse in the U.S. are clearly unsustainable; in an increasingly global and competitive world, the loss of substantial human capital and enormous costs of managing the health and crime-related dimensions of substance abuse detract from our long-term social and economic strengths. Substance abuse is associated with $166 billion/year of increased healthcare costs alone in the U.S. Public healthcare payers are particularly burdened by widespread substance abuse. Medicaid—which serves a growing proportion of the population, with its expansion under the Affordable Care Act—spends $1 out of every $5 on patients’ substance misuse.

Policy makers and local communities alike are desperately looking for approaches to reduce substance abuse. The current discussion around expanded access to treatment is a step forward, but even the best treatment methods are only successful for a fraction of addicted individuals; and by the time an individual reaches the point of accessing treatment, substantial human, social, and economic damage has often already occurred. The logical solution is to expand effective prevention programs; however, policymakers must be confident that such approaches are cost-effective. Unfortunately, there have been no reliable estimates of the public-payer health care savings attributable to prevention programming.

Employing a low-cost RCT strategy, we leveraged administrative records to evaluate changes in Medicaid health service utilization and spending due to community-wide substance abuse prevention. By using this promising model, this study utilized a valid randomized controlled prevention study to test the downstream impact on Medicaid costs for intervention and control samples. Findings will greatly improve society’s understanding of how universal substance abuse prevention can impact public healthcare utilization and costs, and provide critical insight into issues of tremendous societal importance. This evaluation focused on the ability of PROSPER, a coordinated substance abuse prevention approach, to reduce burden on Medicaid.

Project Team