Evaluation of a theatre production to combat adolscent drug use

How we worked with our project partners

In 2024, Unity Insights was commissioned to work alongside a county council in evaluating the impact of a ‘Theatre in Education’ production delivered to secondary schools across the county, aimed at combating the onset of adolescent drug use. Integrated into the existing PSHE curriculum, with supporting lessons, the programme aims to provide an interactive educational resource exploring social factors affecting the onset of drug use among adolescents, and how to approach them constructively. We were responsible for conducting a health economic cost-benefit analysis investigating the predicted return on investment of the production, as well as a health inequalities analysis exploring factors affecting the onset of drug use and the potential replicability of results in other local authorities.

Health economics

Our health economic analyses began with a literature review to identify the potential benefits of the program, revealing linkages between reductions in drug use and tangible economic benefits. While many potential benefits were identified, three main benefit streams were selected for inclusion on the basis of data availability:

• A reduction in serious youth violence
• A reduction in unemployment
• A reduction in drug-related hospital admissions

The above benefits were linked in literature to varying measures of drug use, both in terms of frequency (i.e., quantity of drug use in a specific time period) and longitudinality (i.e., duration of drug use). As tendencies among attendees to use drugs were only measured in a pre-production survey and a 3-month post-production survey, a 20-year stock-and-flow population modelling exercise was undertaken to model predicted in-year quantities of four types of drug user for intervention and counterfactual scenarios.

Health inequalities

Our health inequalities analysis focussed on the usage of public datasets to build profiles of local authorities across England, exploring factors described in academic literature as impacting upon the onset of adolescent drug use. Factors such as special educational needs (SEN), education, health and care plans (EHCP), free school meals (FSM), and index of multiple deprivation (IMD) were explored as a combination of indirect indicators of increased propensity to engage in adolescent drug use, as well as potential elements influencing the need to alter the delivery of the production to audiences in prospective local authorities. The profile of these factors in the given county was explored relative to the spread of these factors in other local authorities, providing insight into the replicability of evaluation findings in other areas.

What impacts did our work show?

Health economics

When considering all benefits, the series of productions was predicted to result in economic losses over 1-year and 5-year time horizons, before resulting in a positive return on investment over 10-year and 20-year time horizons, with a net present value (NPV) of over £200k and a benefit-cost ratio (BCR) of 3.1.

When excluding social benefits, which are those representing a monetised benefit that is returned to individuals (such as increased incomes and improved quality of life) and focusing on public sector benefits, the productions were predicted to result in economic losses over all time horizons, with a final 20-year NPV of -£30k and BCR of 0.7.

Unemployment-related benefits were predicted to be the largest benefit streams, with increased incomes (social benefit) modelled to represent approximately two thirds of all benefits and increased tax revenue (public benefit) modelled to represent around twenty percent of all benefits. In total, social benefits comprised approximately three quarters of all benefits, with public benefits comprising the remaining quarter of all benefits. Scenario modelling was conducted, exploring theoretical scenarios of implementation across wider geographies, including the entirety of England. The over-arching economic findings remained constant in these scenarios, with slight improvements in total 20-year NPVs and BCRs.

Health inequalities

For all health inequality-related metrics explored, the given county was found to broadly approximate the mean and median values across all local authorities, meaning that it could be seen to represent an average or typical implementation scenario for this programme. As such, prospective implementations of the programme in most local authorities could be predicted to result in similar outcomes and require few alterations to delivery.

Nonetheless, there exist local authorities with considerably higher incidences of SEN, EHCPs, and FSM, as well as being more deprived. For the cases of SEN and EHCPs, these local authorities would potentially require alterations to programme delivery in order to replicate or maximise the identified benefits of the intervention. Areas with high FSM provision and high deprivation may represent the areas of greatest opportunity from this kind of programme, due to the identified links between these metrics and increased drug usage and drug-related deaths, as well as increased health inequalities in access, experience, and outcomes of health and healthcare.

What value did this evaluation add?

As a result of our work, there now exists an economic evidence base supporting the notion of long-term return on investment for theatre programmes integrated into the school curriculum combating the onset of adolescent drug use. The findings generated may be used to support business cases for the introduction of similar programmes within secondary schools in other local authorities, which would be predicted to generate further economic benefit. The health inequalities analysis conducted supplemented this by providing insight into the applicability of findings to other areas of the country, as well as identifying factors for consideration which may influence the delivery of the programme in areas which differ significantly from the given county.