A drug treatment program that has worked ought to have plenty of support from both policymakers and the public. But when it comes to the successes reported with something called contingency management, it’s easy to understand why it’s rarely used.
The Washington Post reported that the program has “a radically simple premise: Get paid to abstain from drugs.”
“The approach, known as ... CM, has racked up a slew of successes. It has been shown to dramatically reduce people’s smoking during pregnancy and to help decrease binge drinking. It is also highly promising for combating methamphetamine addictions.”
Stop right there, many taxpayers will say. Why should somebody be paid not to do something they already shouldn’t be doing? And won’t somebody who gets paid just be tempted to go buy some more drugs?
Those are fair questions. But the answers are that CM has shown significantly above-average results in encouraging drug addicts to quit using narcotics. And someone who’s still on drugs won’t get any money when they flunk their tests.
The typical CM program includes drug tests twice a week. If the participant is clean, he gets either a random prize or something like cash or a gift card. Other behavior, such as showing up for a counseling appointment, can be rewarded as well. For best results, the gifts are immediate, to reinforce positive behavior right away.
The Post reported that patients in CM programs are more than twice as likely to remain clean than those who are not. That alone is a strong signal that CM is worth exploring, but there’s another benefit as well.
“CM is incredibly cost-effective,” the Post said. “No surprise there — a single emergency-room visit for meth-induced psychosis can easily cost more than three months of cash rewards.” To put numbers on it, an ER visit, often subsidized by taxpayers, costs $550. An ambulance ride is $1,200. And in the worst cases, two weeks in jail costs $1,360.
CM has been researched since the 1970s, when a Johns Hopkins professor recruited 10 former heroin addicts — who were still using other drugs — for a trial program in which they would receive rewards for staying clean.
The 10 people took drug tests twice a week for three months, and by the end, seven of them had reduced their use. Over the years, some studies have found that patients started using drugs again when the incentive went away. That highlights the importance of counseling and other services to help people stay clean.
Even so, CM has produced the best results in keeping addicts away from drugs. This should encourage states to experiment with it, but there are other problems besides resistance to the way it pays participants.
A serious structural roadblock is that the federal health care system has not created a billing code for CM. That’s important because health care providers need a billing code to get paid, whether from private or government-funded insurance.
The Post said California, Montana and Washington are either operating CM programs or in the process of setting them up.
In California, lawmakers who bicker about everything agreed without a single dissenting vote last year to expand access to CM programs across the state. The senator who introduced the bill said he thought it would be controversial, but once members of both parties looked at the program, they were persuaded it was worth trying.
Mississippi, as we all know, has plenty of people with drug problems. CM, which focuses on treatment, sounds like something that would fit in nicely with existing drug court efforts. Policymakers ought to look at this closely.
— Jack Ryan, McComb Enterprise-Journal
