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This article reports during-treatment outcomes from a randomized, controlled evaluation of different schedules of judicial status hearings in a misdemeanor drug court. Contrary to expectations, more frequent status hearings with the drug court judge were not associated with more favorable outcomes for participants during the first 14 weeks of drug court in terms of counseling attendance, urinalysis-confirmed abstinence, self-reported substance use, or illegal activity. More frequent hearings were, however, associated with greater detection of infractions by the drug court judge and more remedial interventions with participants. Future research will address 6-, 12-, and 24-month follow-up outcomes for these individuals and will examine the generalizability of the findings across several adult drug courts.

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The following review considers data on the validity of self-reports in addict populations, and then it discusses (a) the types of cost-related questions and the assumptions underlying them that are useful to the evaluation of addictions treatment, (b) both internal and external sources of invalidity, (c) the limits on cost-related information that is gathered from administrative databases, (d) methods for assessing measure validity, and (e) the means for improving the validity of self-reports of cost events. With some important exceptions, addicts provide valid data about both medical and criminal cost events. Skilled socioeconomic researchers able to monetarize these events should be able to produce significant cost of illness, cost offset, cost-benefit, and cost-effectiveness research using self-report data.

OBJECTIVES. The purpose of this study was to develop a model, using the epidemiologic tool of attributable risk, for estimating the cost of substance abuse to Medicaid. METHODS. Based on prior substance-use and morbidity research, population attributable risks for substance abuse-related diseases were calculated. (These risks measure the proportion of total disease cases attributable to smoking, drinking, and drug use.) The risks for each disease were applied to Medicaid hospital discharges and days on the 1991 National Hospital Discharge Survey that had these diseases as primary diagnoses. The cost of these substance abuse-related days were added to Medicaid hospital costs for direct treatment of substance abuse. RESULTS. More than 60 medical conditions involving 1100 diagnoses were identified, at least in part, as attributable to substance abuse. Factoring these substance abuse-related conditions into hospital costs, 1 out of 5 Medicaid hospital days, or 4 million days, were spent on substance abuse-related care in 1991. In 1994, this would account for almost $8 billion in Medicaid expenditures. CONCLUSIONS. The use of tobacco, alcohol, and drugs contributes significantly to hospital costs. To address rising costs, substance abuse treatment and prevention should be an integral part of any health care reform effort.