Drug users to get shop vouchers

England implements a large contingency management pilot.

Questions:

  • If the numbers suggest it’s an effective strategy to keep people in treatment and the post-treatment numbers look good, but the public resents the program and it engenders more stigma, is it the right thing to do?
  • Why are we not talking about this kind of intervention with non-compliant patients in cardiac care units, diabetes clinics, weight loss programs, etc.?
    (UPDATE: I was going to resist responding to my own question but I’m weak. Is it because we respect them too much to offer gift certificates for following their treatment plan.)

2 thoughts on “Drug users to get shop vouchers

  1. Enjoying all the thought-provoking topics on this blog. I’ve posted some thoughts on incentives at the Brandywine Counseling Blog – here’s a summary:Question 1 – Yes, incentives are the right thing to do, even if the public doesn’t understand it. In our case, even our counselors needed some help understanding it. We introduced an educational slogan, “Participation = Celebration,” that we think will help.Question 2 – I have yet to hear that any of our clients have felt insulted at being offered a reward. I’ve been told that incentives programs have been proven to improve treatment outcomes even when the clients say the incentives didn’t make a difference. The same might just be true in other settings.

  2. Thanks for your comments.Two responses:You said “even if the public doesn’t understand it?” What if incentives increase stigma and it can’t be overcome with public education? I think this is a real possibility and I believe stigma is an enormous barrier to recovery. I think it’s also possible that incentives might be a manifestation of stigma. “The subtle bigotry of low expectations.” This segues into the second question. Lots of problems could be addressed by paying people to do the right thing. Why don’t we do it? Should we pay hypertension, diabetes or obesity patients to comply with their treatment plan? Why don’t we see proposals to do this? They have noncompliance rates similar or worse than those of addicts.

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