A health services use framework for drug-abusing offenders

This article reviews the recent literature on health services use by drug abusers. A revised Andersen-Newman model is posited as a theoretical orientation for health service initiatives focused on drug abuse. The model highlights specific predisposing factors, historical health factors, current illness factors, and enabling/mediating factors associated with drug abuse. The limited number of cost-effectiveness studies have demonstrated that publicly funded drug treatment can produce savings by reducing selected health care costs and decreasing crime. However, short-term costs related to drug abuse can be greater to realize than long-term savings. The criminal justice system can serve as a point of contact and provides a concentrated reservoir of drug users. However, drug-abusing offenders are more likely to present a variety of health problems including hepatitis, tuberculosis, and HIV/AIDS. From a managed care and health services use perspective, drug abuse treatment in the criminal justice system should minimize long-term health care-and crime-related costs.