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Open Access Short Report

An investigation of scale effects in family substance abuse treatment programs

A James Lee

Author Affiliations

Department of Community Health and Sustainability, School of Health and Environment, University of Massachusetts Lowell, 300 Weed Hall, 3 Solomont Way Lowell, MA 01854, USA

Substance Abuse Treatment, Prevention, and Policy 2010, 5:14  doi:10.1186/1747-597X-5-14

Published: 5 July 2010


This short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families) was too small to be economical. Although the sample size (just nine programs) was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's) Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW) Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.