Peer recovery support services like recovery coaching are shown to play an important role in the substance use disorder continuing care and like many other recovery support services are likely to prove cost-effective, but this question hasn’t been formally evaluated. This innovative study modeled the potential cost-effectiveness of providing recovery coaching for 1 year after receiving treatment.
l
Peer recovery support services like recovery coaching have been shown to play an important role in the substance use disorder care continuum by helping individuals engage with and stay in treatment. This in turn can improve outcomes for individuals seeking substance use disorder recovery, while also reducing disease and mortality associated with unresolved substance use disorder. As we learn more about the effects of recovery coaching from rigorous experimental and quasi-experimental studies, it is also important to learn about the costs of such services needed to produce their potential enhanced outcomes. Preliminary work suggests this may translate into cost savings to healthcare systems and society, however, no studies to date have rigorously explored this.
In this study, researchers conducted an innovative modeling study to examine the economic impact of recovery coaching following residential substance use disorder treatment, relative to continuing care as usual without recovery coaching.
This was an innovative “microsimulation” study to model an economic evaluation of peer recovery support services for substance use disorder using publicly available data on service utilization, outcomes, and associated costs. As a comparator, the researchers also modeled the economic impact of substance use disorder continuing care as usual (i.e., no recovery coaching). Where possible, the researchers focused on data from 2019 to avoid the impacts of the COVID-19 pandemic.
The researchers’ economic evaluation was conducted from both a healthcare systems perspective, and a societal perspective across the entire United States using a nationally representative sample to estimate the number of people with substance use disorder receiving specialty treatment. Their calculation of the economic impacts included factors like peer worker pay, recovery coaching utilization, and cost of specialty care. For the cost from the healthcare systems perspective, they also estimated averted medical costs, while their calculation of the economic impact on society included per-person averted societal costs (e.g., criminal justice involvement and lost productivity), and the per-person, per-episode patient time costs for participating in recovery coaching.
The researchers ran a simulation model that estimated outcomes and associated costs for two cohorts of individuals completing inpatient treatment for substance use disorder who subsequently received either 1 year of recovery coaching or no recovery coaching. After receiving recovery coaching or continuing care as usual, participants were modeled to enter 1 of 3 health states at frequencies indicated by previous research: 1) recovery (operationalized as abstinence or sustained, reduced substance use); 2) “chaotic” substance use, which is a term often used to describe hazardous and/or life-altering substance use; or 3) deceased. The simulated cohort began at age 38 (i.e., the average US treatment population age) and quality-adjusted life expectancy—a measure that reflects both the quantity and quality of life lived—was estimated through age 82.
The study measured cost-effectiveness in terms of quality-adjusted life years, a widely used metric in public health research related to healthy life years that provides a comprehensive measure of health benefits associated with an intervention. The researchers also estimated the number of people in recovery, i.e., the number of individuals who remained in substance use disorder remission following either recovery coaching, or care as usual following residential treatment.
Based on their analysis, the researchers also developed a free, web-based, recovery coaching cost-effectiveness calculator. This tool allows users to input specific data about their recovery coaching programs and estimate tailored cost-effectiveness results.
For healthcare systems, recovery coaching adds cost but likely saves money in the long-run
The researchers’ model estimated that recovery coaching cost approximately $3 billion in 2019. This included costs to healthcare systems of delivering recovery coaching, as well as time costs for the individuals receiving recovery coaching. However, at model year 3, this resulted in 570,000 additional quality adjusted life years and an additional 320,000 people in recovery versus continuing care as usual. This translated to a $5,900 cost to healthcare systems and individuals receiving recovery coaching per quality adjusted life year added, and a $10,500 cost per additional person in recovery. Importantly, when recovery coaching was modeled as less effective – e.g., more individuals in the cohort returned to problematic use – costs were substantially higher, at $250,000 per quality adjusted life year added and $450,000 per additional person in recovery. Thus, the more effective recovery coaching is, the less expensive it is to the healthcare system.
While the researchers’ model highlighted that recovery coaching comes with some increased cost, it also indicated that recovery coaching leads to cost savings in the long run because these outcome benefits translate into lower treatment readmission rates. The model indicated that 75% of the time, assuming the estimated $17,200 cost associated with someone having to return to residential treatment following a relapse, post-treatment recovery coaching will be cost-effective. If, assuming the cost of subsequent residential treatment is greater than $50,000 (which in many cases would be true given individuals may require multiple subsequent treatment episodes), then providing recovery coaching would be cost-effective to healthcare systems more than 85% of the time.
For society, providing recovery coaching saves money up front and results in better outcomes
The researchers model estimated that providing recovery coaching saved US society $5.7 billion up front in 2019. This factors in the cost of delivering recovery coaching (the cost saving to society of providing standard substance use disorder care is $7.7 billion). Given they estimated that recovery coaching results in 570,000 additional quality adjusted life years and an additional 320,000 people in recovery at model year 3, this translated to a $3,400 cost to society associated with recovery coaching per quality adjusted life year added, and a $6,100 cost to society per additional person in recovery at 3 years. These costs were fully offset by the subsequent savings provided by recovery coaching.
The model indicated that 61% of the time, assuming the estimated $17,200 cost to healthcare systems associated with someone having to return to residential treatment following a relapse, post-treatment recovery coaching will be cost-effective. If assuming the cost of subsequent residential treatment is greater than $50,000, then providing recovery coaching would be cost-effective to society more than 94% of the time.
These findings add to a growing body of research highlighting the promise of recovery coaching for substance use disorder. Though implementing recovery coaching invariably costs money up front, based on these simulated models, these costs are likely to be offset by the long-term savings to both healthcare systems and society. These types of healthcare and societal cost savings have been observed when substance use disorder patients are linked to other recovery support services including mutual-help groups like Alcoholics Anonymous (AA) or when they reside in a sober living environment versus at home. Importantly, recovery coaching is generally less expensive to implement than other beneficial interventions. The researchers note, for instance, that methadone treatment for opioid use disorder costs an estimated $16,000 per quality adjusted life year added – a substantially greater cost relative to recovery coaching, which cost between $3,400 and $5,900 for each quality adjusted life year added. Though not necessarily a replacement for substance use disorder treatment, recovery coaching will likely confer most benefit when added to, and extending, existing care.
Despite the promise of recovery coaching and its already substantial uptake in healthcare systems and communities, experimental and quasi-experimental research is needed to test whether it improves substance use and other important recovery outcomes like recovery capital. That said, this innovative study suggests it is ultimately likely to be a cost-effective approach to address the clinical, financial, and public health burden of substance use in the United States.
This economic simulation model indicates recovery coaching post residential treatment is cost-effective compared to continuing care as usual, and suggests significant benefits, both in terms of healthy life years and additional people in recovery, as well as costs to healthcare systems and society. While experimental and quasi-experimental studies are needed to test whether recovery coaching improves substance use and other recovery outcomes, the practical and economic benefits highlighted by this study speak to the promise of recovery coaching’s broader adoption and integration into substance use disorder recovery systems of care.
Castedo de Martell, S., Wilkerson, J. M., Ranjit, N., Holleran Steiker, L., McCurdy, S. A., & Shelton Brown, H., 3rd. (2025). What we know about the peer workforce and economic evaluation for peer recovery support services: A systematic review. Substance Use & Addiction Journal, 46(1), 90-102. doi: 10.1177/29767342241281009.
l
Peer recovery support services like recovery coaching have been shown to play an important role in the substance use disorder care continuum by helping individuals engage with and stay in treatment. This in turn can improve outcomes for individuals seeking substance use disorder recovery, while also reducing disease and mortality associated with unresolved substance use disorder. As we learn more about the effects of recovery coaching from rigorous experimental and quasi-experimental studies, it is also important to learn about the costs of such services needed to produce their potential enhanced outcomes. Preliminary work suggests this may translate into cost savings to healthcare systems and society, however, no studies to date have rigorously explored this.
In this study, researchers conducted an innovative modeling study to examine the economic impact of recovery coaching following residential substance use disorder treatment, relative to continuing care as usual without recovery coaching.
This was an innovative “microsimulation” study to model an economic evaluation of peer recovery support services for substance use disorder using publicly available data on service utilization, outcomes, and associated costs. As a comparator, the researchers also modeled the economic impact of substance use disorder continuing care as usual (i.e., no recovery coaching). Where possible, the researchers focused on data from 2019 to avoid the impacts of the COVID-19 pandemic.
The researchers’ economic evaluation was conducted from both a healthcare systems perspective, and a societal perspective across the entire United States using a nationally representative sample to estimate the number of people with substance use disorder receiving specialty treatment. Their calculation of the economic impacts included factors like peer worker pay, recovery coaching utilization, and cost of specialty care. For the cost from the healthcare systems perspective, they also estimated averted medical costs, while their calculation of the economic impact on society included per-person averted societal costs (e.g., criminal justice involvement and lost productivity), and the per-person, per-episode patient time costs for participating in recovery coaching.
The researchers ran a simulation model that estimated outcomes and associated costs for two cohorts of individuals completing inpatient treatment for substance use disorder who subsequently received either 1 year of recovery coaching or no recovery coaching. After receiving recovery coaching or continuing care as usual, participants were modeled to enter 1 of 3 health states at frequencies indicated by previous research: 1) recovery (operationalized as abstinence or sustained, reduced substance use); 2) “chaotic” substance use, which is a term often used to describe hazardous and/or life-altering substance use; or 3) deceased. The simulated cohort began at age 38 (i.e., the average US treatment population age) and quality-adjusted life expectancy—a measure that reflects both the quantity and quality of life lived—was estimated through age 82.
The study measured cost-effectiveness in terms of quality-adjusted life years, a widely used metric in public health research related to healthy life years that provides a comprehensive measure of health benefits associated with an intervention. The researchers also estimated the number of people in recovery, i.e., the number of individuals who remained in substance use disorder remission following either recovery coaching, or care as usual following residential treatment.
Based on their analysis, the researchers also developed a free, web-based, recovery coaching cost-effectiveness calculator. This tool allows users to input specific data about their recovery coaching programs and estimate tailored cost-effectiveness results.
For healthcare systems, recovery coaching adds cost but likely saves money in the long-run
The researchers’ model estimated that recovery coaching cost approximately $3 billion in 2019. This included costs to healthcare systems of delivering recovery coaching, as well as time costs for the individuals receiving recovery coaching. However, at model year 3, this resulted in 570,000 additional quality adjusted life years and an additional 320,000 people in recovery versus continuing care as usual. This translated to a $5,900 cost to healthcare systems and individuals receiving recovery coaching per quality adjusted life year added, and a $10,500 cost per additional person in recovery. Importantly, when recovery coaching was modeled as less effective – e.g., more individuals in the cohort returned to problematic use – costs were substantially higher, at $250,000 per quality adjusted life year added and $450,000 per additional person in recovery. Thus, the more effective recovery coaching is, the less expensive it is to the healthcare system.
While the researchers’ model highlighted that recovery coaching comes with some increased cost, it also indicated that recovery coaching leads to cost savings in the long run because these outcome benefits translate into lower treatment readmission rates. The model indicated that 75% of the time, assuming the estimated $17,200 cost associated with someone having to return to residential treatment following a relapse, post-treatment recovery coaching will be cost-effective. If, assuming the cost of subsequent residential treatment is greater than $50,000 (which in many cases would be true given individuals may require multiple subsequent treatment episodes), then providing recovery coaching would be cost-effective to healthcare systems more than 85% of the time.
For society, providing recovery coaching saves money up front and results in better outcomes
The researchers model estimated that providing recovery coaching saved US society $5.7 billion up front in 2019. This factors in the cost of delivering recovery coaching (the cost saving to society of providing standard substance use disorder care is $7.7 billion). Given they estimated that recovery coaching results in 570,000 additional quality adjusted life years and an additional 320,000 people in recovery at model year 3, this translated to a $3,400 cost to society associated with recovery coaching per quality adjusted life year added, and a $6,100 cost to society per additional person in recovery at 3 years. These costs were fully offset by the subsequent savings provided by recovery coaching.
The model indicated that 61% of the time, assuming the estimated $17,200 cost to healthcare systems associated with someone having to return to residential treatment following a relapse, post-treatment recovery coaching will be cost-effective. If assuming the cost of subsequent residential treatment is greater than $50,000, then providing recovery coaching would be cost-effective to society more than 94% of the time.
These findings add to a growing body of research highlighting the promise of recovery coaching for substance use disorder. Though implementing recovery coaching invariably costs money up front, based on these simulated models, these costs are likely to be offset by the long-term savings to both healthcare systems and society. These types of healthcare and societal cost savings have been observed when substance use disorder patients are linked to other recovery support services including mutual-help groups like Alcoholics Anonymous (AA) or when they reside in a sober living environment versus at home. Importantly, recovery coaching is generally less expensive to implement than other beneficial interventions. The researchers note, for instance, that methadone treatment for opioid use disorder costs an estimated $16,000 per quality adjusted life year added – a substantially greater cost relative to recovery coaching, which cost between $3,400 and $5,900 for each quality adjusted life year added. Though not necessarily a replacement for substance use disorder treatment, recovery coaching will likely confer most benefit when added to, and extending, existing care.
Despite the promise of recovery coaching and its already substantial uptake in healthcare systems and communities, experimental and quasi-experimental research is needed to test whether it improves substance use and other important recovery outcomes like recovery capital. That said, this innovative study suggests it is ultimately likely to be a cost-effective approach to address the clinical, financial, and public health burden of substance use in the United States.
This economic simulation model indicates recovery coaching post residential treatment is cost-effective compared to continuing care as usual, and suggests significant benefits, both in terms of healthy life years and additional people in recovery, as well as costs to healthcare systems and society. While experimental and quasi-experimental studies are needed to test whether recovery coaching improves substance use and other recovery outcomes, the practical and economic benefits highlighted by this study speak to the promise of recovery coaching’s broader adoption and integration into substance use disorder recovery systems of care.
Castedo de Martell, S., Wilkerson, J. M., Ranjit, N., Holleran Steiker, L., McCurdy, S. A., & Shelton Brown, H., 3rd. (2025). What we know about the peer workforce and economic evaluation for peer recovery support services: A systematic review. Substance Use & Addiction Journal, 46(1), 90-102. doi: 10.1177/29767342241281009.
l
Peer recovery support services like recovery coaching have been shown to play an important role in the substance use disorder care continuum by helping individuals engage with and stay in treatment. This in turn can improve outcomes for individuals seeking substance use disorder recovery, while also reducing disease and mortality associated with unresolved substance use disorder. As we learn more about the effects of recovery coaching from rigorous experimental and quasi-experimental studies, it is also important to learn about the costs of such services needed to produce their potential enhanced outcomes. Preliminary work suggests this may translate into cost savings to healthcare systems and society, however, no studies to date have rigorously explored this.
In this study, researchers conducted an innovative modeling study to examine the economic impact of recovery coaching following residential substance use disorder treatment, relative to continuing care as usual without recovery coaching.
This was an innovative “microsimulation” study to model an economic evaluation of peer recovery support services for substance use disorder using publicly available data on service utilization, outcomes, and associated costs. As a comparator, the researchers also modeled the economic impact of substance use disorder continuing care as usual (i.e., no recovery coaching). Where possible, the researchers focused on data from 2019 to avoid the impacts of the COVID-19 pandemic.
The researchers’ economic evaluation was conducted from both a healthcare systems perspective, and a societal perspective across the entire United States using a nationally representative sample to estimate the number of people with substance use disorder receiving specialty treatment. Their calculation of the economic impacts included factors like peer worker pay, recovery coaching utilization, and cost of specialty care. For the cost from the healthcare systems perspective, they also estimated averted medical costs, while their calculation of the economic impact on society included per-person averted societal costs (e.g., criminal justice involvement and lost productivity), and the per-person, per-episode patient time costs for participating in recovery coaching.
The researchers ran a simulation model that estimated outcomes and associated costs for two cohorts of individuals completing inpatient treatment for substance use disorder who subsequently received either 1 year of recovery coaching or no recovery coaching. After receiving recovery coaching or continuing care as usual, participants were modeled to enter 1 of 3 health states at frequencies indicated by previous research: 1) recovery (operationalized as abstinence or sustained, reduced substance use); 2) “chaotic” substance use, which is a term often used to describe hazardous and/or life-altering substance use; or 3) deceased. The simulated cohort began at age 38 (i.e., the average US treatment population age) and quality-adjusted life expectancy—a measure that reflects both the quantity and quality of life lived—was estimated through age 82.
The study measured cost-effectiveness in terms of quality-adjusted life years, a widely used metric in public health research related to healthy life years that provides a comprehensive measure of health benefits associated with an intervention. The researchers also estimated the number of people in recovery, i.e., the number of individuals who remained in substance use disorder remission following either recovery coaching, or care as usual following residential treatment.
Based on their analysis, the researchers also developed a free, web-based, recovery coaching cost-effectiveness calculator. This tool allows users to input specific data about their recovery coaching programs and estimate tailored cost-effectiveness results.
For healthcare systems, recovery coaching adds cost but likely saves money in the long-run
The researchers’ model estimated that recovery coaching cost approximately $3 billion in 2019. This included costs to healthcare systems of delivering recovery coaching, as well as time costs for the individuals receiving recovery coaching. However, at model year 3, this resulted in 570,000 additional quality adjusted life years and an additional 320,000 people in recovery versus continuing care as usual. This translated to a $5,900 cost to healthcare systems and individuals receiving recovery coaching per quality adjusted life year added, and a $10,500 cost per additional person in recovery. Importantly, when recovery coaching was modeled as less effective – e.g., more individuals in the cohort returned to problematic use – costs were substantially higher, at $250,000 per quality adjusted life year added and $450,000 per additional person in recovery. Thus, the more effective recovery coaching is, the less expensive it is to the healthcare system.
While the researchers’ model highlighted that recovery coaching comes with some increased cost, it also indicated that recovery coaching leads to cost savings in the long run because these outcome benefits translate into lower treatment readmission rates. The model indicated that 75% of the time, assuming the estimated $17,200 cost associated with someone having to return to residential treatment following a relapse, post-treatment recovery coaching will be cost-effective. If, assuming the cost of subsequent residential treatment is greater than $50,000 (which in many cases would be true given individuals may require multiple subsequent treatment episodes), then providing recovery coaching would be cost-effective to healthcare systems more than 85% of the time.
For society, providing recovery coaching saves money up front and results in better outcomes
The researchers model estimated that providing recovery coaching saved US society $5.7 billion up front in 2019. This factors in the cost of delivering recovery coaching (the cost saving to society of providing standard substance use disorder care is $7.7 billion). Given they estimated that recovery coaching results in 570,000 additional quality adjusted life years and an additional 320,000 people in recovery at model year 3, this translated to a $3,400 cost to society associated with recovery coaching per quality adjusted life year added, and a $6,100 cost to society per additional person in recovery at 3 years. These costs were fully offset by the subsequent savings provided by recovery coaching.
The model indicated that 61% of the time, assuming the estimated $17,200 cost to healthcare systems associated with someone having to return to residential treatment following a relapse, post-treatment recovery coaching will be cost-effective. If assuming the cost of subsequent residential treatment is greater than $50,000, then providing recovery coaching would be cost-effective to society more than 94% of the time.
These findings add to a growing body of research highlighting the promise of recovery coaching for substance use disorder. Though implementing recovery coaching invariably costs money up front, based on these simulated models, these costs are likely to be offset by the long-term savings to both healthcare systems and society. These types of healthcare and societal cost savings have been observed when substance use disorder patients are linked to other recovery support services including mutual-help groups like Alcoholics Anonymous (AA) or when they reside in a sober living environment versus at home. Importantly, recovery coaching is generally less expensive to implement than other beneficial interventions. The researchers note, for instance, that methadone treatment for opioid use disorder costs an estimated $16,000 per quality adjusted life year added – a substantially greater cost relative to recovery coaching, which cost between $3,400 and $5,900 for each quality adjusted life year added. Though not necessarily a replacement for substance use disorder treatment, recovery coaching will likely confer most benefit when added to, and extending, existing care.
Despite the promise of recovery coaching and its already substantial uptake in healthcare systems and communities, experimental and quasi-experimental research is needed to test whether it improves substance use and other important recovery outcomes like recovery capital. That said, this innovative study suggests it is ultimately likely to be a cost-effective approach to address the clinical, financial, and public health burden of substance use in the United States.
This economic simulation model indicates recovery coaching post residential treatment is cost-effective compared to continuing care as usual, and suggests significant benefits, both in terms of healthy life years and additional people in recovery, as well as costs to healthcare systems and society. While experimental and quasi-experimental studies are needed to test whether recovery coaching improves substance use and other recovery outcomes, the practical and economic benefits highlighted by this study speak to the promise of recovery coaching’s broader adoption and integration into substance use disorder recovery systems of care.
Castedo de Martell, S., Wilkerson, J. M., Ranjit, N., Holleran Steiker, L., McCurdy, S. A., & Shelton Brown, H., 3rd. (2025). What we know about the peer workforce and economic evaluation for peer recovery support services: A systematic review. Substance Use & Addiction Journal, 46(1), 90-102. doi: 10.1177/29767342241281009.
SIGN UP FOR THE BULLETIN
