In It to Quit It

The drug overdose mortality rate in California is 10,901 deaths per year, which is the highest out of all 50 states (Center for Disease Control and Prevention). To combat this rate, California legislature decided to pave a new path toward widespread sobriety through contingency management. Addicts can earn small incentives or payments for every negative drug test over a certain period of time. People who complete the program without any positive tests earn a sum of money that is supplied into a gift card. In 2021, the federal government found success testing contingency management with military veterans who have had addictions to stimulants in places where there are no pharmaceutical treatments available. Gov. Gavin Newsom asked the federal government to use tax dollars to fund contingency management in California through Medicaid, a program that gives low-income people access to health services. A bill to make this legal is currently circulating through the state legislature. Economics experts are not afraid of the cost to fund the programs as it costs $286,000 per 1,000 people, which is only a small dent in comparison to California’s operating budget of over $262 million. In the 24 weeklong program, the payments increase by small increments each week, so by the end of the program, they can earn up to $599 (Associated Press News). The idea of earning money attracts many addicts to contingency management because they believe that it will cure their habits. However, it is not worthwhile to put effort into a program that only focuses on external rewards, rather than internal motivation as the driving factor towards sobriety. 

“I feel conflicted about [contingency management] using tax dollars,” senior Christopher Yeh said. “On one hand, it could prevent [addicts] from becoming homeless, or from hurting their families if it works. On the other hand, we are only paying them because they did drugs [in the first place]. A lot of the time, addiction stems from underlying issues, such as trouble at home or stress, and unless those problems are solved, one might resume doing drugs.”

While economics is still a deciding factor in this matter, the duration of the implemented program needs to be considered. Since contingency management is a short-term program, it will, in turn, warrant short-term results. Rehabilitation facilities and programs have been a concept since the 1930s, and have shown that dedication over a long period of time can lead to long-term sobriety. Treatment that lasts less than 90 days offers some results, but longer stays ensure a lasting quality that contingency management lacks (Peaks Recovery Centers). Rehabilitation programs provide addicts with resources they need for recovery and time to cleanse themselves of addictive substances. Along with this, rehabilitation programs use scientifically proven methods to obtain results, such as illness-specific treatment and cognitive behavioral therapy (Peaks Recovery Center). In short-term programs, total abstinence from drugs leads to a greater likelihood of relapse. Rehabilitation centers also offer medication therapy, the use of medication in order to begin the process of detox. Certain medications, like methadone and buprenorphine, are administered and prescribed by medical professionals in controlled conditions, where they are safe for treating particular drug addictions. Having medical therapy before detox can be a very helpful tool, because it eases the transition of acclimating their bodies to withstand the lack of drugs entering their systems. This has been proven effective, since nearly 50% of those who receive medication-assisted treatment for detox successfully complete treatment and achieve abstinence (Meta Addiction Treatment). Overall, therapy programs provide a wide range of support for addicts through medicine and community support that is not as accessible in contingency management.

“There should be different programs explored before we definitively settle on contingency management,” Economics and Advanced Placement Economics teacher Allen Aronson said. “There are so many unknown parameters surrounding contingency management that it is hard to say what the best solution is. For now, we should find alternatives before the bill is passed.” 

A large part of how contingency management stays successful for a short period of time is because in order for them to want to recover, addicts need to perceive the foreseeable benefits that sobriety holds. Money is a physical object that they can see increase over time, however mental benefits, such as happiness and energy, are more difficult for them to understand as benefits of sobriety when preoccupied with an addiction. It is also very easy to get looped into the idea of getting paid for negative drug tests because they get the money after short increments of time, but rehabilitation programs require an immense amount of motivation just to begin the process of recovery. This can be seen through 54-year-old J.W. ‘s experience with contingency management, and how it impacted him. J.W. was given multiple Safeway gift cards over the course of 12 weeks for showing up to appointments, negative drug tests or taking his medication. He expressed how much he valued these gift cards as they gave him the opportunity to buy himself treats that would otherwise not be as accessible to him. After 12 weeks passed, J.W. relapsed. Even though he was initially motivated by the idea of money, it was not enough for him to stay sober. J.W.’s story also shows that his sobriety was dependent on an external reward. For a longer-lasting effect, addicts need internal motivation that can only be offered through therapies in rehabilitation centers (Cal Matters). Cognitive behavioral therapy offers a way for patients to modify their attitude toward drug use by altering addicts’ attitude towards drugs which, in turn, affects their actions.

“I can understand how people can get hooked on the idea of receiving money for something they think they can easily control,” senior Aazaan Chhabra said. “However, I think the appeal of that fades away after they see that the money will not make them feel any better or change their habits.”