The first collegiate recovery program was founded at Brown University in 1977. Since then, these programs have seen explosive growth, with 136 currently in operation. Universities are often tasked with determining whether programs are worth their cost. This study investigated the cost-effectiveness of collegiate recovery programs.
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College recovery programs provide aid, resources, a sense of community, and tailored programs designed to support students in recovery from substance use disorder, help them face challenges on college campuses, and achieve their educational goals.
In 2013, there were only 29 across the United States. Although, this represents a tiny proportion of the approximately 5,300 colleges and universities across the country, since 2013, there has been considerable growth, relatively speaking, in these education-based recovery support services. Although the absolute number of these programs remains low, the relative increase may be due in part from advocacy and the opioid overdose crisis. As of 2024, for example, according to the Association of Recovery in Higher Education, there are currently 136 programs in operation. The impacts of collegiate recovery programs have yet to be examined using rigorous quantitative study designs that can determine whether participation is causing stable or improved outcomes. However, many of the resources they provide are empirically-supported, such as continuing care and mutual-help facilitation.
While research examining the utility of collegiate recovery program participation is ongoing, understanding program costs and potential cost savings are also important financial considerations for higher education stakeholders who might adopt more of this programming if cost savings were found to be favorable. This study drew from health economics to conduct a cost-effectiveness analysis of collegiate recovery programs.
The current cost-effectiveness study was a secondary data analysis of two national surveys of collegiate recovery programs conducted in 2012 and 2017, which provided the key variables of mean budget and mean membership size. Several other parameters (e.g., cost of tuition, cost of a substance use disorder treatment episode) were drawn from other published studies or publicly available data. The study sought to determine the cost-effectiveness from a societal and an institutional perspective.
The societal perspective first identified program characteristics such as budget, cost-per student to society, and adjusted for the proportion of students who may return to use. Then, the researchers drew from a large epidemiological study to create a score, called a quality adjusted life expectancy (QALE), that quantifies how many years of good health a person in recovery has above what a person with substance use disorder who does not initiate recovery might have. Of note, the recovery outcomes estimated here are not specific to collegiate recovery programs but rather what would be expected if someone with substance use disorder were to initiate and sustain recovery.
The current study compared participation in a collegiate recovery program to an episode of substance use disorder treatment. While these two are not mutually-exclusive, this comparison is based on the assumption that if a student in recovery were to experience relapse (i.e., reinstatement of the disorder) they might require treatment to then reinstate remission and recovery. With respect to cost-effectiveness, the difference between the cost of a collegiate recovery program and the cost of a single substance use disorder treatment episode (estimated at $16,866) is divided by the difference in their respective quality adjusted life expectancy scores (i.e., recovery versus ongoing substance use disorder) to arrive at an incremental cost-effectiveness ratio (or “ICER”). This ratio captures the cost for each year of good health resulting from collegiate recovery program participation above that resulting from a treatment episode.
The institutional perspective consisted of two models, intended to examine costs if the university has a collegiate recovery program compared to a scenario where the university does not have one. The first institutional model considers the opportunity cost of lost tuition due to substance use-related attrition and the opportunity cost for key campus staff whose time is occupied by students with untreated substance use disorders. The second institutional model incorporates the cost of onboarding students to replace those unenrolled due to substance-related issues. For these analyses, the numerator is the number of students retained due to the presence of a collegiate recovery program. The cost of retaining these students with active substance use disorder was calculated across resources with which these students may commonly engage, such as the college counseling center, student conduct offices, and the occasional interaction with campus police related to substance-related offenses. The outcome of each institutional model is again an incremental cost-effectiveness ratio, which in these analyses is the cost to the institution per student retained due to a collegiate recovery program compared to what would result if a collegiate recovery program were not present and the burden was on standard college resources.
A base case for each model was created and reported. Additional sensitivity analyses were conducted that adjusted parameters to investigate how changes in key parameters (e.g., budget, size) impacted the cost-effectiveness of a collegiate recovery program. Both the societal and institutional cost-effectiveness models were converted into a cost-effectiveness calculator that is publicly available and allows for users to enter specific information about an existing or proposed collegiate recovery program. For example, a user can enter a specific program budget and size as well as details about the campus where program is located to get an incremental cost-effectiveness ratio based on their own data for each model. In addition to the calculator, there are also video tutorials and additional documentation freely available at https://collegiaterecovery.org/media/.
The societal perspective — collegiate recovery programs save money compared to treatment
The incremental cost-effectiveness ratio, or the cost per year of good health gained, showed a cost saving of $3,873 when implementing a collegiate recovery program compared to the potential cost of a substance use disorder treatment episode for each student enrolled in the program. In the case of membership size, when all other parameters are held constant, at least 10 members are needed to constitute a cost savings. However, the cost is still less than an additional treatment episode and less than the commonly used benchmark for the acceptable cost of an additional year of good health.
The institutional perspective – collegiate recovery programs are cost-saving compared to lost tuition
The base model of cost-effectiveness when considering the opportunity cost of lost tuition found that the presence of a collegiate recovery program saves $11,231 for each student retained in the program who would have otherwise left the school. The cost of tuition, program budget, membership size, and rate of reoccurrence of use did impact the cost-effectiveness. When tuition fell below $14,000, a collegiate recovery program was no longer cost-effective. However, a collegiate recovery program remains cheaper than providing substance use disorder treatment up to a return to use rate of 81%.
Collegiate recovery programs not cost saving but less than the cost of onboarding new students
In the institutional model where the cost of a collegiate recovery program is compared to the cost of onboarding new students, a collegiate recovery program cost $14,581 per student retained. This is due to the cost of onboarding new students being substantially less than the lost revenue from tuition. This case may apply to those schools where tuition and fees are relatively low.
The prevalence of substance use disorders among full-time college students is high, with 14% meeting criteria according to nationally representative surveys. Collegiate recovery programs provide aid, resources, a sense of community, and tailored programs for students so they may continue both their recovery and education journeys. An important consideration for education and recovery stakeholders is the cost-effectiveness of collegiate recovery programs. This study – which assumed that collegiate recovery programs help maintain or enhance recovery compared to standard college campus services – found that collegiate recovery programs were generally cost-effective from both a societal and a tuition-based institutional perspectives.
The findings for this study, however, include detailed information regarding potential costs of collegiate recovery programs versus an episode of treatment, but the outcomes are theoretical; they were based on epidemiological data comparing quality adjusted life years for recovery compared to substance use disorder rather than collegiate recovery program participation versus standard college campus services.
Furthermore, as with any cost-effective analysis, there is the possibility that important parameters are not included. For example, the nature and quantity of volunteer hours provided by collegiate recovery program and community members is not included nor are costs associated with criminal justice, health care, or lost productivity. It may be possible that collegiate recovery programs are more cost-effective than indicated here if they are associated with reductions in these financial burdens. Also, collegiate recovery programs may help universities specifically attract individuals in recovery interested in advancing their education but who would not otherwise attend college if such a program were not available. In these cases, some sources of tuition for universities may depend on the presence of collegiate recovery programs.
Considering and including these parameters will be important to distill key cost or benefits. A previous cost-effectiveness study of recovery management checkups – a continuing care intervention designed to help people get back into treatment sooner if they need it – found when these societal costs like health services, social services, criminal justice, and employment, are considered, the cost-effectiveness of recovery management check-ups may be greater. As research proceeds examining the utility of collegiate recovery programs on students’ substance use and recovery capital including educational accomplishments, studies like these examining costs and potential cost-savings will aid decisions regarding funding these education-based recovery supports.
Collegiate recovery programs may constitute a unique option in the menu of treatment and recovery services for college students. The analyses in this study suggest that collegiate recovery programs are generally cost-effective. The analyses are limited, however, due to the scant data on the effectiveness, more generally, of collegiate recovery programs. Additional data would strengthen reliability and accuracy in the cost-effectiveness of collegiate recovery programs. Recovery and education stakeholders can also use the cost-effectiveness calculator (https://collegiaterecovery.org/media/) to obtain a tailored cost-effectiveness estimate to aid budgetary decisions around collegiate recovery programming.
Castedo De Martell, S., Holleran Steiker, L., Springer, A., Jones, J., Eisenhart, E., & Brown Iii, H. S. (2024). The cost-effectiveness of collegiate recovery programs. Journal of American College Health, 72(1), 82–93. doi.: 10.1080/07448481.2021.2024206
l
College recovery programs provide aid, resources, a sense of community, and tailored programs designed to support students in recovery from substance use disorder, help them face challenges on college campuses, and achieve their educational goals.
In 2013, there were only 29 across the United States. Although, this represents a tiny proportion of the approximately 5,300 colleges and universities across the country, since 2013, there has been considerable growth, relatively speaking, in these education-based recovery support services. Although the absolute number of these programs remains low, the relative increase may be due in part from advocacy and the opioid overdose crisis. As of 2024, for example, according to the Association of Recovery in Higher Education, there are currently 136 programs in operation. The impacts of collegiate recovery programs have yet to be examined using rigorous quantitative study designs that can determine whether participation is causing stable or improved outcomes. However, many of the resources they provide are empirically-supported, such as continuing care and mutual-help facilitation.
While research examining the utility of collegiate recovery program participation is ongoing, understanding program costs and potential cost savings are also important financial considerations for higher education stakeholders who might adopt more of this programming if cost savings were found to be favorable. This study drew from health economics to conduct a cost-effectiveness analysis of collegiate recovery programs.
The current cost-effectiveness study was a secondary data analysis of two national surveys of collegiate recovery programs conducted in 2012 and 2017, which provided the key variables of mean budget and mean membership size. Several other parameters (e.g., cost of tuition, cost of a substance use disorder treatment episode) were drawn from other published studies or publicly available data. The study sought to determine the cost-effectiveness from a societal and an institutional perspective.
The societal perspective first identified program characteristics such as budget, cost-per student to society, and adjusted for the proportion of students who may return to use. Then, the researchers drew from a large epidemiological study to create a score, called a quality adjusted life expectancy (QALE), that quantifies how many years of good health a person in recovery has above what a person with substance use disorder who does not initiate recovery might have. Of note, the recovery outcomes estimated here are not specific to collegiate recovery programs but rather what would be expected if someone with substance use disorder were to initiate and sustain recovery.
The current study compared participation in a collegiate recovery program to an episode of substance use disorder treatment. While these two are not mutually-exclusive, this comparison is based on the assumption that if a student in recovery were to experience relapse (i.e., reinstatement of the disorder) they might require treatment to then reinstate remission and recovery. With respect to cost-effectiveness, the difference between the cost of a collegiate recovery program and the cost of a single substance use disorder treatment episode (estimated at $16,866) is divided by the difference in their respective quality adjusted life expectancy scores (i.e., recovery versus ongoing substance use disorder) to arrive at an incremental cost-effectiveness ratio (or “ICER”). This ratio captures the cost for each year of good health resulting from collegiate recovery program participation above that resulting from a treatment episode.
The institutional perspective consisted of two models, intended to examine costs if the university has a collegiate recovery program compared to a scenario where the university does not have one. The first institutional model considers the opportunity cost of lost tuition due to substance use-related attrition and the opportunity cost for key campus staff whose time is occupied by students with untreated substance use disorders. The second institutional model incorporates the cost of onboarding students to replace those unenrolled due to substance-related issues. For these analyses, the numerator is the number of students retained due to the presence of a collegiate recovery program. The cost of retaining these students with active substance use disorder was calculated across resources with which these students may commonly engage, such as the college counseling center, student conduct offices, and the occasional interaction with campus police related to substance-related offenses. The outcome of each institutional model is again an incremental cost-effectiveness ratio, which in these analyses is the cost to the institution per student retained due to a collegiate recovery program compared to what would result if a collegiate recovery program were not present and the burden was on standard college resources.
A base case for each model was created and reported. Additional sensitivity analyses were conducted that adjusted parameters to investigate how changes in key parameters (e.g., budget, size) impacted the cost-effectiveness of a collegiate recovery program. Both the societal and institutional cost-effectiveness models were converted into a cost-effectiveness calculator that is publicly available and allows for users to enter specific information about an existing or proposed collegiate recovery program. For example, a user can enter a specific program budget and size as well as details about the campus where program is located to get an incremental cost-effectiveness ratio based on their own data for each model. In addition to the calculator, there are also video tutorials and additional documentation freely available at https://collegiaterecovery.org/media/.
The societal perspective — collegiate recovery programs save money compared to treatment
The incremental cost-effectiveness ratio, or the cost per year of good health gained, showed a cost saving of $3,873 when implementing a collegiate recovery program compared to the potential cost of a substance use disorder treatment episode for each student enrolled in the program. In the case of membership size, when all other parameters are held constant, at least 10 members are needed to constitute a cost savings. However, the cost is still less than an additional treatment episode and less than the commonly used benchmark for the acceptable cost of an additional year of good health.
The institutional perspective – collegiate recovery programs are cost-saving compared to lost tuition
The base model of cost-effectiveness when considering the opportunity cost of lost tuition found that the presence of a collegiate recovery program saves $11,231 for each student retained in the program who would have otherwise left the school. The cost of tuition, program budget, membership size, and rate of reoccurrence of use did impact the cost-effectiveness. When tuition fell below $14,000, a collegiate recovery program was no longer cost-effective. However, a collegiate recovery program remains cheaper than providing substance use disorder treatment up to a return to use rate of 81%.
Collegiate recovery programs not cost saving but less than the cost of onboarding new students
In the institutional model where the cost of a collegiate recovery program is compared to the cost of onboarding new students, a collegiate recovery program cost $14,581 per student retained. This is due to the cost of onboarding new students being substantially less than the lost revenue from tuition. This case may apply to those schools where tuition and fees are relatively low.
The prevalence of substance use disorders among full-time college students is high, with 14% meeting criteria according to nationally representative surveys. Collegiate recovery programs provide aid, resources, a sense of community, and tailored programs for students so they may continue both their recovery and education journeys. An important consideration for education and recovery stakeholders is the cost-effectiveness of collegiate recovery programs. This study – which assumed that collegiate recovery programs help maintain or enhance recovery compared to standard college campus services – found that collegiate recovery programs were generally cost-effective from both a societal and a tuition-based institutional perspectives.
The findings for this study, however, include detailed information regarding potential costs of collegiate recovery programs versus an episode of treatment, but the outcomes are theoretical; they were based on epidemiological data comparing quality adjusted life years for recovery compared to substance use disorder rather than collegiate recovery program participation versus standard college campus services.
Furthermore, as with any cost-effective analysis, there is the possibility that important parameters are not included. For example, the nature and quantity of volunteer hours provided by collegiate recovery program and community members is not included nor are costs associated with criminal justice, health care, or lost productivity. It may be possible that collegiate recovery programs are more cost-effective than indicated here if they are associated with reductions in these financial burdens. Also, collegiate recovery programs may help universities specifically attract individuals in recovery interested in advancing their education but who would not otherwise attend college if such a program were not available. In these cases, some sources of tuition for universities may depend on the presence of collegiate recovery programs.
Considering and including these parameters will be important to distill key cost or benefits. A previous cost-effectiveness study of recovery management checkups – a continuing care intervention designed to help people get back into treatment sooner if they need it – found when these societal costs like health services, social services, criminal justice, and employment, are considered, the cost-effectiveness of recovery management check-ups may be greater. As research proceeds examining the utility of collegiate recovery programs on students’ substance use and recovery capital including educational accomplishments, studies like these examining costs and potential cost-savings will aid decisions regarding funding these education-based recovery supports.
Collegiate recovery programs may constitute a unique option in the menu of treatment and recovery services for college students. The analyses in this study suggest that collegiate recovery programs are generally cost-effective. The analyses are limited, however, due to the scant data on the effectiveness, more generally, of collegiate recovery programs. Additional data would strengthen reliability and accuracy in the cost-effectiveness of collegiate recovery programs. Recovery and education stakeholders can also use the cost-effectiveness calculator (https://collegiaterecovery.org/media/) to obtain a tailored cost-effectiveness estimate to aid budgetary decisions around collegiate recovery programming.
Castedo De Martell, S., Holleran Steiker, L., Springer, A., Jones, J., Eisenhart, E., & Brown Iii, H. S. (2024). The cost-effectiveness of collegiate recovery programs. Journal of American College Health, 72(1), 82–93. doi.: 10.1080/07448481.2021.2024206
l
College recovery programs provide aid, resources, a sense of community, and tailored programs designed to support students in recovery from substance use disorder, help them face challenges on college campuses, and achieve their educational goals.
In 2013, there were only 29 across the United States. Although, this represents a tiny proportion of the approximately 5,300 colleges and universities across the country, since 2013, there has been considerable growth, relatively speaking, in these education-based recovery support services. Although the absolute number of these programs remains low, the relative increase may be due in part from advocacy and the opioid overdose crisis. As of 2024, for example, according to the Association of Recovery in Higher Education, there are currently 136 programs in operation. The impacts of collegiate recovery programs have yet to be examined using rigorous quantitative study designs that can determine whether participation is causing stable or improved outcomes. However, many of the resources they provide are empirically-supported, such as continuing care and mutual-help facilitation.
While research examining the utility of collegiate recovery program participation is ongoing, understanding program costs and potential cost savings are also important financial considerations for higher education stakeholders who might adopt more of this programming if cost savings were found to be favorable. This study drew from health economics to conduct a cost-effectiveness analysis of collegiate recovery programs.
The current cost-effectiveness study was a secondary data analysis of two national surveys of collegiate recovery programs conducted in 2012 and 2017, which provided the key variables of mean budget and mean membership size. Several other parameters (e.g., cost of tuition, cost of a substance use disorder treatment episode) were drawn from other published studies or publicly available data. The study sought to determine the cost-effectiveness from a societal and an institutional perspective.
The societal perspective first identified program characteristics such as budget, cost-per student to society, and adjusted for the proportion of students who may return to use. Then, the researchers drew from a large epidemiological study to create a score, called a quality adjusted life expectancy (QALE), that quantifies how many years of good health a person in recovery has above what a person with substance use disorder who does not initiate recovery might have. Of note, the recovery outcomes estimated here are not specific to collegiate recovery programs but rather what would be expected if someone with substance use disorder were to initiate and sustain recovery.
The current study compared participation in a collegiate recovery program to an episode of substance use disorder treatment. While these two are not mutually-exclusive, this comparison is based on the assumption that if a student in recovery were to experience relapse (i.e., reinstatement of the disorder) they might require treatment to then reinstate remission and recovery. With respect to cost-effectiveness, the difference between the cost of a collegiate recovery program and the cost of a single substance use disorder treatment episode (estimated at $16,866) is divided by the difference in their respective quality adjusted life expectancy scores (i.e., recovery versus ongoing substance use disorder) to arrive at an incremental cost-effectiveness ratio (or “ICER”). This ratio captures the cost for each year of good health resulting from collegiate recovery program participation above that resulting from a treatment episode.
The institutional perspective consisted of two models, intended to examine costs if the university has a collegiate recovery program compared to a scenario where the university does not have one. The first institutional model considers the opportunity cost of lost tuition due to substance use-related attrition and the opportunity cost for key campus staff whose time is occupied by students with untreated substance use disorders. The second institutional model incorporates the cost of onboarding students to replace those unenrolled due to substance-related issues. For these analyses, the numerator is the number of students retained due to the presence of a collegiate recovery program. The cost of retaining these students with active substance use disorder was calculated across resources with which these students may commonly engage, such as the college counseling center, student conduct offices, and the occasional interaction with campus police related to substance-related offenses. The outcome of each institutional model is again an incremental cost-effectiveness ratio, which in these analyses is the cost to the institution per student retained due to a collegiate recovery program compared to what would result if a collegiate recovery program were not present and the burden was on standard college resources.
A base case for each model was created and reported. Additional sensitivity analyses were conducted that adjusted parameters to investigate how changes in key parameters (e.g., budget, size) impacted the cost-effectiveness of a collegiate recovery program. Both the societal and institutional cost-effectiveness models were converted into a cost-effectiveness calculator that is publicly available and allows for users to enter specific information about an existing or proposed collegiate recovery program. For example, a user can enter a specific program budget and size as well as details about the campus where program is located to get an incremental cost-effectiveness ratio based on their own data for each model. In addition to the calculator, there are also video tutorials and additional documentation freely available at https://collegiaterecovery.org/media/.
The societal perspective — collegiate recovery programs save money compared to treatment
The incremental cost-effectiveness ratio, or the cost per year of good health gained, showed a cost saving of $3,873 when implementing a collegiate recovery program compared to the potential cost of a substance use disorder treatment episode for each student enrolled in the program. In the case of membership size, when all other parameters are held constant, at least 10 members are needed to constitute a cost savings. However, the cost is still less than an additional treatment episode and less than the commonly used benchmark for the acceptable cost of an additional year of good health.
The institutional perspective – collegiate recovery programs are cost-saving compared to lost tuition
The base model of cost-effectiveness when considering the opportunity cost of lost tuition found that the presence of a collegiate recovery program saves $11,231 for each student retained in the program who would have otherwise left the school. The cost of tuition, program budget, membership size, and rate of reoccurrence of use did impact the cost-effectiveness. When tuition fell below $14,000, a collegiate recovery program was no longer cost-effective. However, a collegiate recovery program remains cheaper than providing substance use disorder treatment up to a return to use rate of 81%.
Collegiate recovery programs not cost saving but less than the cost of onboarding new students
In the institutional model where the cost of a collegiate recovery program is compared to the cost of onboarding new students, a collegiate recovery program cost $14,581 per student retained. This is due to the cost of onboarding new students being substantially less than the lost revenue from tuition. This case may apply to those schools where tuition and fees are relatively low.
The prevalence of substance use disorders among full-time college students is high, with 14% meeting criteria according to nationally representative surveys. Collegiate recovery programs provide aid, resources, a sense of community, and tailored programs for students so they may continue both their recovery and education journeys. An important consideration for education and recovery stakeholders is the cost-effectiveness of collegiate recovery programs. This study – which assumed that collegiate recovery programs help maintain or enhance recovery compared to standard college campus services – found that collegiate recovery programs were generally cost-effective from both a societal and a tuition-based institutional perspectives.
The findings for this study, however, include detailed information regarding potential costs of collegiate recovery programs versus an episode of treatment, but the outcomes are theoretical; they were based on epidemiological data comparing quality adjusted life years for recovery compared to substance use disorder rather than collegiate recovery program participation versus standard college campus services.
Furthermore, as with any cost-effective analysis, there is the possibility that important parameters are not included. For example, the nature and quantity of volunteer hours provided by collegiate recovery program and community members is not included nor are costs associated with criminal justice, health care, or lost productivity. It may be possible that collegiate recovery programs are more cost-effective than indicated here if they are associated with reductions in these financial burdens. Also, collegiate recovery programs may help universities specifically attract individuals in recovery interested in advancing their education but who would not otherwise attend college if such a program were not available. In these cases, some sources of tuition for universities may depend on the presence of collegiate recovery programs.
Considering and including these parameters will be important to distill key cost or benefits. A previous cost-effectiveness study of recovery management checkups – a continuing care intervention designed to help people get back into treatment sooner if they need it – found when these societal costs like health services, social services, criminal justice, and employment, are considered, the cost-effectiveness of recovery management check-ups may be greater. As research proceeds examining the utility of collegiate recovery programs on students’ substance use and recovery capital including educational accomplishments, studies like these examining costs and potential cost-savings will aid decisions regarding funding these education-based recovery supports.
Collegiate recovery programs may constitute a unique option in the menu of treatment and recovery services for college students. The analyses in this study suggest that collegiate recovery programs are generally cost-effective. The analyses are limited, however, due to the scant data on the effectiveness, more generally, of collegiate recovery programs. Additional data would strengthen reliability and accuracy in the cost-effectiveness of collegiate recovery programs. Recovery and education stakeholders can also use the cost-effectiveness calculator (https://collegiaterecovery.org/media/) to obtain a tailored cost-effectiveness estimate to aid budgetary decisions around collegiate recovery programming.
Castedo De Martell, S., Holleran Steiker, L., Springer, A., Jones, J., Eisenhart, E., & Brown Iii, H. S. (2024). The cost-effectiveness of collegiate recovery programs. Journal of American College Health, 72(1), 82–93. doi.: 10.1080/07448481.2021.2024206
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