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Subst Abuse. 2019 Aug 20;13:1178221819870768. doi: 10.1177/1178221819870768. eCollection 2019.

The Value of Outdoor Behavioral Healthcare for Adolescent Substance Users with Comorbid Conditions.

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University of New Hampshire, Durham, NH, USA.
Trajectory® Healthcare Loveland, OH, USA.
Redcliff Ascent, Enterprise, UT, USA.


The damage inflicted on our society by mental health and substance use issues is reaching epidemic proportions with few signs of abating. One new and innovative strategy for addressing these comorbid issues has been the development of outdoor behavioral healthcare (OBH). This study compared the effectiveness of three post-acute adolescent substance use situations: OBH, treatment as usual (TAU), and no structured treatment (NST). The simulated target population was 13-17 years old with comorbid substance use and mental health issues. When costs were adjusted for actual completion rates of 94% in OBH, 37% in TAU, and $0 for NST, the actual treatment costs per person were $27 426 for OBH and $31 113 for TAU. OBH also had a cost-benefit ratio of 60.4% higher than TAU, an increased Quality in Life Years (QALY) life span, societal benefits of an additional $36 100, and 424% better treatment outcomes as measured by the Youth Outcome Questionnaire (YOQ) research instrument.


comorbidity; cost-effectiveness; substance use treatment; treatment completion rates

Conflict of interest statement

Declaration of conflicting interest:The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The lead author is paid a partial summer stipend of his university salary by the Outdoor Behavioral Healthcare Council, the National Association of Therapeutic Schools and Programs, and Eastern Baltimore charities to advise and organize research projects for any youth programs in need of therapeutic programing. However none of these organizations have any influence on who the author assists in conducting research projects, the research projects selected for investigation, their preparation and conduct of research, nor the production and conclusion in resulting published manuscripts. All other authors of the manuscript declare no conflict of interest.

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