Paying meth users to stay clean

San Francisco is trying it, and it looks as if it works.

San Francisco has come up with an imaginative substitute for conventional drug treatment: drug testing with payment for “clean” results. This is the flip side of (or could be a complement to) the testing-and-sanctions approach that I have long advocated for probationers under the label “coerced abstinence.”

What’s fascinating is that even quite modest material rewards have large impacts on behavior. That was already known from experimental work but it’s reassuring to find it confirmed at full scale. The modesty of the rewards virtually eliminates any moral hazard: i.e., the risk of someone trying to be diagnosed as a meth abuser in order to receive payments for ceasing meth abuse.

It’s a fair question whether the effects of such programs will outlast the treatment effort itself. In the experimental work, contingency reinforcement to change behaviors the subjects independently wanted to change did have carryover benefits, but paying people to change behaviors they didn’t want to change only worked as long as the payments lasted.

Of course, the same question could be asked about conventional treatment; there’s no particular reason to think that counseling has a longer effect half-life than contingency management. Likely the benefits of the program while it runs are sufficient to cover its (modest) costs, even if its residual benefits were zero.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: