06/22/2016 09:45 EDT | Updated 06/22/2016 09:59 EDT

Should We Pay People Not To Take Drugs?

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White powder on black shiny surface, looks like drug pile

The War on Drugs has been a failure. Trying to control the production, sale, and use of recreational drugs through the criminal law has imposed unbearable costs: unjust incarceration, illicit markets, tainted substances, exploited children, and an untaxed industry. The War will end. Drugs will be legalized and regulated with marijuana leading the way. Using drugs will shift from a criminal to a public health issue.

But many challenges will remain. Anti-drug myths depict users as addicts. But only a minority of substance users of most drugs actually become dependent. Nevertheless, these small number of individuals can inflict great damage upon themselves, their families, communities etc. There are many schools of thought and practice regarding how best to prevent dependence and to respond to it effectively when it does develop. These strategies need to be implemented and assessed in rigorous ways.

And what if we paid people not to engage in harmful consumption? If we rewarded them for stopping damaging use? Couldn't the savings in all manner of costs greatly outweigh the comparatively small expense of any incentive?

There are many forceful objections from doing so. People should not be rewarded for doing (or not doing) various things that are simply part of the basics of healthy living. If we pay individuals to not do something a bunch of irresponsible types will start the activity just to collect the payout for quitting. A number will stop long enough to collect then just go back to their unhealthy ways etc, etc.

But both the public and private sector for some time now have been offering rewards to promote what are taken to be good decisions in a number of areas. In an earlier post I've written about how incentives exist to promote all manner of activities from going to the gym to saving for retirement; from participating in easing of traffic congestion to getting kids to be more physically active.

There are programs underway in the US to keep kids at risk away from guns by paying them to stay clear of firearms.

We have already begun experimenting with rewards to encourage people to stop harmful use of drugs. The one recreational drug that leads the way in toxicity and power to create dependence is nicotine. People should not start smoking. Period. But for those who are smoking providing incentives to stop may be a key strategy.

I've previously discussed a very successful cigarette cessation program sponsored by CVS, the pharmacy chain, for its employees. The initiative was a complicated scheme of penalties and rewards. Suffice it to say here that many more individuals used the reward scheme to try to quit. Moreover, the results of the CVS sponsored initiative produced better cessation results than therapy or using substitutes for nicotine such as patches.

Now efforts in Britain and France are focussing on pregnant women and providing them incentives not to smoke while carrying a child (and, hopefully, after the baby is born). This initiative has caused a stir. Critics assert the arguments against such rewards, cited above, and others. But if these programs are effective many infants will be shielded from the damaging effects of nicotine and at least some mothers will quit permanently.

What about cocaine? Yes, that's right. Experiments conducted in a Vermont clinic demonstrated that problem cocaine users can achieve and maintain abstinence at a higher rate when counselling is combined with vouchers for a small amount ($2.50-$12 a day). Control groups only received counselling or only received vouchers.

In follow up studies of the Vermont experiment those who received vouchers and counselling during the experimental period were still more likely to be drug free even when the vouchers were no longer being offered than those in the control groups.

None of this is to suggest that rewards are a cure all for harmful use of drugs. Certainly, a litmus test for any such initiatives is effectiveness: they must be demonstrated to reduce excessive use on a sustainable basis. Nor should they deflect resources from more established methods of treatment that work. These approaches are unorthodox and may be shocking to some. But shouldn't we be open to searching for what works?

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