The impact of substance abuse treatment modality on birth weight and health care expenditures

During the 1990s, substance abuse treatment programs were developed for pre gnant women to help improve infant birth outcomes, reduce maternal drug dep endency and promote positive lifestyle changes. This study compared the rel ative impact of five treatment modalities-residential, outpatient, resident ial/outpatient, methadone and detoxification-only-on infant birth weight an d perinatal health care expenditures for a sample of 445 Medicaid-eligible pregnant women who received treatment in Massachusetts between 1992 and 199 7. Costs and outcomes were measured using the Addiction Severity Index and data from birth certificates, substance abuse treatment records and Medicai d claims. Multiple regression was used to control for intake differences be tween the groups. Results showed a near linear relationship between birth w eight and amount of treatment received. Women who received the most treatme nt (the residential/outpatient group) delivered infants who were 190 grams heavier than those who received the least treatment (the detoxification-onl y group) for an additional cost of $17,211. Outpatient programs were the mo st cost-effective option, increasing birth weight by 139 grams over detoxif ication-only for an investment of only $1,788 in additional health care and treatment costs. A second regression using five intermediate treatment out comes-prenatal care, weight gain, relapse, tobacco use and infection-sugges ted that increases in birth weight were due primarily to improved nutrition and reduced drug use, behaviors which are perhaps more easily influenced i n residential settings.