One of the most important unanswered questions for any society is how best to invest in children’s mental health. Childhood is a sensitive and opportune period in which to invest in programs and services that can mitigate a range of downstream risks for health and mental health conditions. Investing in such programs and services will require a shift from focusing not only on reducing deficits but also enhancing the child’s skills and other assets. Economic evaluation is crucial for determining which programs and services represent optimal investments. Several registries curate lists of programs with high evidence of effectiveness; many of these programs also have evidence of positive benefit-cost differentials, although the economic evidence is typically limited and uncertain. Even the programs with the strongest evidence are currently reaching only a small fraction of young people who would potentially benefit. Thus, it is important to understand and address factors that impede or facilitate the implementation of best practices. One example of a program that represents a promising investment is home visiting, in which health workers visit the homes of new parents to advise on parenting skills, child needs, and the home environment. Another example is social emotional learning programs delivered in schools, where children are taught to regulate emotions, manage behaviors, and enhance relationships with peers. Investing in these and other programs with a strong evidence base, and assuring their faithful implementation in practice settings, can produce improvements on a range of mental health, academic, and social outcomes for children, extending into their lives as adults.
Daniel Eisenberg and Ramesh Raghavan
Dominic Hodgkin and Hilary S. Connery
Drug and alcohol use disorders, also called substance use disorders (SUD), are among the major health problems facing many countries, contributing a substantial burden in terms of mortality, morbidity, and economic impact. A considerable body of research is dedicated to reducing the social and individual burden of SUD. One major focus of research has been the effectiveness of treatment for SUD, with studies examining both medication and behavioral treatments using randomized, controlled clinical trials. For opioid use disorder, there is a strong evidence base for medication treatment, particularly using agonist therapies (i.e., methadone and buprenorphine), but mixed evidence regarding the use of psychosocial interventions. For alcohol use disorder, there is evidence of modest effectiveness for two medications (acamprosate and naltrexone) and for various psychosocial treatments, especially for less severe alcohol use disorder syndromes. An important area for future research is how to make treatment more appealing to clients, given that client reluctance is an important contributor to the low utilization of effective treatments. A second major focus of research has been the availability of medication treatments, building on existing theories of how innovations diffuse, and on the field of dissemination and implementation research. In the United States, this research identifies serious gaps in both the availability of SUD treatment programs and the availability of effective treatment within those programs. Key barriers include lack of on-site medical staff at many SUD treatment programs; restrictive policies of private insurers, states, and federal authorities; and widespread skepticism toward medication treatment among counseling staff and some administrators. Emerging research is promising for providing medication treatment in settings other than SUD treatment programs, such as community mental health centers, prisons, emergency departments, and homeless shelters. There is still considerable room to make SUD treatment approaches more effective, more available, and—most importantly—more acceptable to clients.