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February 25, 2021

"What If We Pay People to Stop Using Drugs?"

The question in the title of this post is the headline of this New Republic piece by Zachary Siegel.  Its subheadline captures its themes: "Traditional treatments often take place in expensive facilities, demand total abstinence, and rely on punitive methods of control.  A harm reduction model turns all of that on its head."  Here is an excerpt (with links from the original):

In contingency management programs, a positive urine screen does not result in punishment the way it might in other treatment programs, especially when those are court mandated and using drugs can result in jail time.  The only negative reinforcement in contingency management is that a positive urine screen means the reward cycle resets, along with the bonus count.  You have to start over. 

“People can come high,” Mike Discepola, vice president of behavioral and substance use health at the San Francisco AIDS Foundation, said.  The whole idea of the program is to match a participant’s interest with their ability, Discepola explained.  If someone is continually testing positive for stimulants, then treatment, counseling, and care are still available to them.  If a participant tests positive, they’re encouraged to discuss why they used, and counselors try to motivate them to keep showing up and try again.  No one gets turned away, and no one gets punished for using again.

But that’s exactly what conventional treatment, and the legal system, does.  People who use drugs are often given an ultimatum to either comply with an abstinence-focused treatment program or go to jail.  In Pennsylvania, one type of probation called “addict supervision” runs on a strict zero-tolerance approach where if participants test positive for drugs, or even miss a drug test, they’re detained and potentially given an even harsher sentence than the one they are hoping to avoid by agreeing to supervision in the first place.  All this, mind you, for low-level drug arrests and minor offenses.  Federal data from 2012 shows that 44 percent of men aged 19 to 49 who are on probation or parole could benefit from addiction treatment, but just over one-quarter actually get it.  Even when they do, it’s hard to know if that treatment is truly grounded in compassionate health care or just punishment by another name....

Providing financial incentives is a common practice in health care and most of our regular lives.  Employers offer their workers gym memberships and Fitbits to encourage certain behavior.  If you’ve ever used points earned on a credit card or accumulated miles from traveling, that’s an incentive, too....

Prevailing stigmas and stereotypes label people who use drugs as selfish, irresponsible, and criminal.  Why pay them money? Aren’t they just going to buy more drugs?  Attitudes against “coddling” people who use drugs are often deployed to prevent effective harm reduction interventions from being implemented.  Rod Rosenstein, Trump’s former deputy attorney general, argued against supervised consumption sites in The New York Times, saying the goal was to “fight drug abuse, not subsidize it.”  

February 25, 2021 at 05:34 PM | Permalink


I think I have a great idea. Any Drug charged person, who is non-violent and in Prison, Federal or State. After 6 months- 2 years (depending on charge) should be able to post a "retainer" to go home and start their Supervised release. The retainer should be an amount depending on their sentence. If they violate, they lose that retainer (or whomever put it up for them) and cannot apply to do it again till another 2 years has past and they have gone through a program in Prison. Then the Retainer doubles if they choose to try again.
If they make it to their "off paper date" they are refunded the retainer, minus drug testing and Programs they are required to take. It would create more jobs, Cure Mass Incarceration, Keeps families together especially children who need their parent and inspire them to get their acts together.
I would be first to do this because I know my loved one would walk a very straight line. "Post Sentence Bonding" Not sure why the Gov. never can think outside the box, there are so many ways to help people, and weed out the ones who really have changed mentally and gotten their acts together, who deserve a chance. There is no reason someone should spend more than 4 years in prison for any kind of drug charge, it ruins their chances to get there lives together sitting in there for decades. How is someone supposed to get a job and their lives together after 15 years in prison? Impossible, hence the revolving door. Wake up lawmakers.

Posted by: Lisa Sciretta | Feb 25, 2021 10:11:49 PM

I agree, but hazard the issue of Hunter Biden. Big money but endless repeats of rehab.

Posted by: Brenda Rossini | Feb 26, 2021 8:22:11 AM

Brenda Rossini, thank you so much for the profound insight. A single individual, Hunter Biden, is both wealthy and experiences substance addition relapses on occasion. Thus, it clearly follows that the article and the underlying methodologies being discussed—which don't mention him at all and have nothing to do with him or people in a comparable situation—are hopelessly flawed and should be retracted and abandoned. How embarrassing to the author and researchers not to have thought of this sooner before expending all this time and effort on a new treatment approach. Good thing you brought this to everyone's attention before it really got out of hand. You're a modern-day savior.

Posted by: hardreaders | Feb 27, 2021 2:47:51 PM

This is an overly-simplistic view of addiction, which reflects a lack of insight about the disease of addiction. Addicts and alcoholics cannot control their behaviors and urges to use and consume alcohol and drugs. Offering them money to stop using assumes that they are rational decision-makers and are capable of controlling their own behaviors -- but they are not. Working in a criminal defense law firm, I have seen many heroin addicts who are charged with simple possession of heroin. I have asked the clients if they know anyone who has died from a heroin overdose. Without exception, all of the clients know a few or several people who have overdosed on heroin and died -- yet they continue to use themselves, despite knowing that it may kill them. Addicts and alcoholics are not rational people. Addiction is a disease of the mind, whose goal is to kill the addict. Using drugs is just one symptom of addiction. Addicts who are incarcerated in jail or prison, but don't get help, such as through A.A. or N.A., still engage in twisted, irrational thinking. Offering them money to abstain from using is not the answer.

Posted by: Jim Gormley | Mar 1, 2021 12:45:43 PM

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