Can Money Help People to “Just Say No”?

health related issues, lessons learned, politics, social justice, Teaching and Education, United States 3 Minutes

Overdose deaths from stimulants in California nearly quadrupled between 2010 and 2019, and the problem has gotten even worse since. Preliminary data from the first nine months of 2020 — when much of the state was locked down because of the coronavirus— shows stimulant overdose deaths jumped 42% compared to 2019.

California has proposed a radically different approach to fight this growing problem.

The state is advancing legislation that would pay people to get them to stop using drugs like cocaine and methamphetamine, stimulants for which there are no pharmaceutical treatments available.

It works like this: People earn small incentives or payments for every negative drug test over a period of time. Most people who complete the treatment without any positive tests can earn a few hundred dollars. They usually get the money on a gift card.

It’s called “contingency management” and Gov. Gavin Newsom has asked the federal government for permission to use tax dollars to pay for it through Medicaid, the joint state and federal health insurance program for the poor and disabled that covers nearly 14 million people in California.

Meanwhile, a similar proposal is moving through California’s Democratic-controlled Legislature. It’s already passed the Senate with no opposition and is pending in the Assembly, where it has a Republican co-author.

One example of a similar program is the San Francisco AIDS Foundation, a nonprofit agency, which runs a small, privately-funded contingency management program. It’s where Tyrone Clifford, who was addicted to meth, enrolled because they promised to pay him for every negative test over 12 weeks.

His first payment was $2. That increased slightly with each subsequent negative test for a total of about $330.

I like that the payments start small and grow from there. I think if it started with larger payments, many people would enroll in such a program just for the money. But starting at just $2 would seem to attract people who are serious about wanting to kick their drug habit. Then as you move through the program, the higher payments create an incentive to want to finish the program. I am also guessing it becomes harder to stay on the program with each passing week, so the increasing payments may provide just enough incentive to stick with the program.

While the fear is that some people may enroll in the program just for the money and then turn around and use that money to buy drugs, it doesn’t seem like someone could buy a lot of drugs from the money earned. Thus from a cost-benefit standpoint, the program seems to be a winner. If someone only lasts one week, it’s only cost the state $2. The longer a person stays in the program, the more expensive it gets, but it also seems to increase the odds that a person will be able to kick the drug habit. Which could save the state thousands of dollars in more expensive health care costs for these individuals.

There is “clear and convincing evidence” that the treatment works to keep people sober from drugs like methamphetamine and cocaine, according to an analysis by the California Health Benefits Review Program. However, while research shows it is effective in keeping people sober during the program, the effect doesn’t last much beyond six months after treatment concludes.

That’s why, according to Clifford, who has now been drug-free for 11 years, emphasizes that the extensive group and individual counseling sessions that were part of the program were an effective way to keep him accountable and made him feel part of a community.

Clifford would also consider the treatment a success even if people don’t make it without a positive test.

Why?

For the simple reason that they are trying something.

I applaud California’s willingness to try such a program, and I hope it provides the desired outcomes…

source: CBS Sacramento

*image from PR Week

Published by Jim Borden

A 60-something guy trying to figure out the world, and his place in it. Happily married for 40-plus years, three wonderful sons. Accounting teacher, fitness enthusiast, blogger, reader.

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55 thoughts on “Can Money Help People to “Just Say No”?”

      2. I have not heard of that, but that sounds a little more challenging. Do criminals just go somewhere and say “I am going to shoot someone today.”. and then they get paid not to?

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  2. I feel skeptical about this program, because leave it up to government and they will screw it up somehow, or introduce corruption. But on the face of it, it sounds viable. And I’d much rather my tax dollars be spent on a program like this, than continue to pour it into law enforcement’s failed war on drugs.

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    1. I agree, on the face of it, it seems like a viable option, and it’s better than doing nothing.

      For about $300, I would personally be willing to sponsor one individual in such a program, and I am sure that there are other people like me who would be willing to do the same. Perhaps the entire program could be funded from private sources…

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      1. Maybe it could, but consider the administrative costs. Even if you only pay someone $2 for a negative test, what did that drug test cost? Plus, someone will have to stand there and watch the addict pee in a jar, to make sure there’s no cheating, and that someone will want to be paid. And then scoundrels like me, who don’t use drugs, could game the system. What easy money that would be for me. I’d ace every test. So safeguards that cost money, will have to be put in place to protect this program from rascals like me. And on and on. I suspect the payouts to the addicts would probably be miniscule compared with the overhead costs to administer this program.

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      2. good point about the overhead costs, but perhaps they could divert people who are already working with addicts to serve as monitors for the drug testing. and if it is successful, it seems like the cost savings from fewer drug addicts would more than cover the cost of the program.

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  3. I guess it could be viewed like a popular obesity surgeon’s philosophy: Success isn’t when a patient loses weight, it’s when they stop gaining. Drug recovery might not be when a person stops so much as when they stop increasing the amount they use.

    Long ago, I read that an issue with amphetamines is that they fire off a large percentage of feel-good neurotransmitters while stopping the production of new ones. As the reserve is depleted, more and more is needed to get the high. Then there’s a crash, recovery, and repeat.

    I recall weekend partying friends happily commenting, nearly every single Monday, about not feeling bad. I’d always remind them that they all crashed on Tuesdays… which they’d promptly do again. Most, but not all, eventually walked away. I always wonder what happened to the guy who, when in the presence of meth, reminded me of the old BugsBunny cartoon where he bounced around when over gold

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      1. It’s been interesting to be around partiers. Started in 9th grade, when my family moved and I went from the uptight Just Say No social circle to hanging out with stoners. I never participated, and held my breath when they blew smoke at me. The radical change was one of the best things that ever happened to me… taught me not to judge others by their habits.

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  4. I appreciate that they are trying to come up with new solutions, but I’m a bit skeptical that this would work. It seems that small amounts of money are not much of an incentive for someone with addiction problems. They have to get into an effective treatment program and the most important motivation for them has to be to get clean so they can feel better physically and in terms of their self-esteem.

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    1. I agree with Pete. This program will help but would be much more effective if it is coupled with a requirement that participants also enter and comply with the terms of an accredited drug treatment program. That way the results are more likely to be longer lasting. I served for a few years on the board of a non-profit residential treatment facility for homeless addicts of all kinds and their families. That program also provided vocational training. The program worked wonders by getting addicts clean and giving them the skills and confidence to support themselves and their families, if they had one. One difficulty with these programs is determining long-term success because it is hard to keep track of the participants after they leave the program. Maybe these programs should consider providing a reward for checking in at certain intervals after completing their treatment.

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      1. well said, John. I agree that a formal program is needed, one that holds the person accountable. I like your idea of having people check in periodically after completing treatment. COuld be quite useful in achieving long-term success…

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    3. that’s why I think the small amount of money would attract only those really interested in changing, since they are not doing it for monetary reasons. and I agree that it needs to be part of a broader treatment program that includes counseling…

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  6. You see a man drowning. Do you stop to consider if you are strong enough to pull him from the water? Do you worry that if you get him out, he may well just jump back in? Do you worry about what it will cost you if you do so? Or do you just see someone in need and do everything you can, simply because you can? Or do you turn and walk away because they are the ones who decided to go swimming?

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      1. Probably as bad as there. I used to work in service development for our addiction services but no one ever suggested anything like this. It would be worth a try.

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  9. I know many people who are in recovery for one thing or another. And what consistently works best for them is having an accountability partner. This is because recovery is not a linear process. A person can be sober for 5 years, and then relapse. I do think this CA financial incentive is worth a try, but that addict who does recover with the program will most likely need an accountability partner to continue to stay sober, IMO.

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  11. If someone can actually kick a serious drug habit they’ll make a much bigger return than the small sums mentioned here. Not only will they not have to pay for their drug habit, but my observation is that it’s a whole lot easier to hold down a job when you’re not using. Drugs ain’t free.

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  13. If this scheme works for a few that’s great but as the comments suggest the problem is much more far-reaching and complicated…really cracking down on dealers would be a good start as many blind eyes are turned …

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