Paying Addicts to Get Clean?

By Walter Armstrong 04/19/11

England's new government introduces the world's first-ever 'Recovery Rewards' drug policy. 

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Can cold, hard cash turn junkies into solid citizens? The Brits are dying to find out.

What would it be worth to you in cold, hard cash to kick smack? Would you stay clean for $50 a day plus expenses? Get a job pushing paper for $100? Live in a drug-free house for $200?

With national deficits raging out of control, pay-for-performance plans are all the rage in health-care policy these days, as the US and other nations struggle to cut runaway costs and waste. In England, the left-wing Labour Party’s "harm-reduction" approach to drug addiction, widely applauded just a few years ago, is now being denounced by Conservatives for “parking” junkies on methadone—and the public dole—for months or even years. Presently, over 400,000 Brits receive monthly disability checks from the government because their alcoholism or drug addiction renders them unfit for work. But now they'll have to work for that money. A new drug policy recently passed by Britain's center-right government will require all substance-abusers to go in to treatment before they receive a single pound of government support. Whether the prospect of "payment" will successfully turn these alcoholics and addicts into sober, hard-working homebodies remains to be seen. It will, however, give the Conservatives a record of being “hard on drugs” to run on in the next elections.

Whie this pay-to-play approach has been gaining favor in the U.S., The UK, which is weathering massive budget problems, has been a leading innovator in establishing the reward-for-outcomes approach. The British government is already using cash payments to prompt welfare recipients to return to work, and to prevent ex-cons from returning to prison. Now it's trying to induce drug-abusers in to treatment by withholding their allowance. A brand new policy is being tested at eight organizations a that provide methadone, cash, needles and other services to addicts recovering from heroin or cocaine use. Clean addicts in recovery will be rewarded with their usual stipends. Continuing alcohol or drug users, however, will face the loss of welfare benefits if they fail too many tests or refuse to take part in treatment.

In the past few years, Britain has packed off an estimated 230,000 "hard users" into drug treatment, double the number that agreed to go a decade ago—an achievement that the recently-deposed Labour Party was quite proud of. Even so, drug use in the UK still remains incredibly high, especially in comparison to most other countries in the European Union. In addition, recent Labour Governments have long been attacked for the high price-tags that their drug rehab programs cost British taxpayers—an estimated more than $25 billion a year. That figure  includes the $3 billion paid out to the 400,000 Brits who are unable to work due to their dependence on alcohol or drugs. With cuts in college education and government employees leading to actual riots in the street, it's clear that the old system is now politically untenable.

So while they welcome the new reforms in public,  the British drug-treatment industry has privately been quick to point out some serious flaws: So far the new initiatives have left left “recovery” undefined, which means that it's still unclear what yardsticks they'll use to determine if a specific addict has been cured. Abstinence, employment, and housing are the most likely yardsticks, but local rehabs still have to hammer out the details with British bureaucrats. Also, because rehabs will get paid by the government based on the number of clients they "successfully" treat, many rehabs will be strongly tempted to reduce their risk by cherry-picking clients, accepting only those judged likely to hit the mark, while leaving more desperate addicts out in the cold.

One thing is certain however: The new policy will doubtlessly spur a profitable new black market in clean urine and spike sales of the popular Whizzinator. But the government's  may also convince a sizable group of addicts deprived of the dole that being broke is a lot worse than being wasted. The jury's still out, unfortunately. But we'll let you know how it all works out.

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Walter Armstrong is the Medical Editor at  Saatchi & Saatchi Wellness and the former deputy editor of The Fix. You can find him on Linkedin.

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