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An Ounce of Prevention, a Pound of Uncertainty

The Cost-Effectiveness of School-Based Drug Prevention Programs

by Jonathan P. Caulkins, Susan S. Sohler Everingham, C. Peter Rydell, James Chiesa, Shawn Bushway

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Focuses on school-based drug prevention programs that have proven effective in formal evaluations. Effectiveness at reducing cocaine consumption is inferred from effectiveness at reducing marijuana initiation, and spillover effects on those not participating in the program are accounted for. Given substantial uncertainties in all pertinent factors, the cost-effectiveness estimation framework is constructed to permit easy substitution of alternate values at reader preference or as more information becomes available. The authors conclude that prevention can reduce lifetime cocaine consumption by 2 to 11 percent. Although these effects are small, prevention programs are inexpensive, so that the associated cost-effectiveness values bracket those of a range of enforcement strategies. Treatment, however, appears more cost-effective than prevention. A nationwide drug prevention program would cost only a tiny fraction of what the United States now spends on drug control, but its effect on the cocaine-using population would be modest and slow to accumulate.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Effectiveness at Reducing Cocaine Consumption

  • Chapter Three

    Cost-Effectiveness at Reducing Cocaine Consumption

  • Chapter Four

    Other Benefits

  • Chapter Five

    Nationwide Implementation

  • Chapter Six

    Conclusions and Policy Implications

  • Appendix A

    Estimating Average Lifetime Cocaine Consumption

  • Appendix B

    Prevention's Effectiveness at Reducing Marijuana Initiation

  • Appendix C

    Relationship Between Age of Marijuana Initiation and Lifetme Consumption of Cocaine and Marijuana

  • Appendix D

    Estimating the Magnitude of the Social Multiplier

  • Appendix E

    How Prevention's Cost-Effectiveness Varies Over Time

  • Appendix F

    Estimating the Magnitude of the Market Multiplier

  • Appendix G

    Estimating the Magnitude of the Causation/Correlation Qualifier

  • Appendix H

    Estimating the Magnitude of the Scale-Up Degradation Qualifier

  • Appendix I

    Prevention's Effect on Heavy Alcohol Use and Cigarette Smoking

  • Appendix J

    Accumulation of Prevention's Effect Nationwide

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