G-D3GDY1Q4CX Stick Doesn't Work, Let's Try The Carrot - Recovery Machine Podcast

full

Stick Doesn't Work, Let's Try The Carrot

$1800 to go to treatment for 90 days. That's the proposal. We take a closer look.

#treatmentincentive #rehabearnings #cashfornodrugs #treatmentideas

RECOVERY MACHINE PODCAST

🔊 All Platforms: https://recovery-machine.captivate.fm/listen

▶ YouTube Handle: https://youtube.com/@recoverymachine?sub_confirmation=1

✔ Website: https://recoverymachine.org

📭 EMAIL Corey and Nathan at  us@recoverymachine.org

🙏 To support Recovery Machine on PATREON: https://www.patreon.com/recmach

TWITTER:  @rcvrymachine

FACEBOOK:  https://www.facebook.com/recoverymachine

INSTAGRAM: https://www.instagram.com/recoverymachinepodcast/

SPOTIFY: https://recovery-machine.captivate.fm/listenspot

AMAZON PODCASTS: https://recovery-machine.captivate.fm/recmachamazon

APPLE PODCASTS: https://recovery-machine.captivate.fm/recmachapple

GOOGLE PODCASTS: https://recovery-machine.captivate.fm/recmachgoogle

Transcript
Corey:

So Nathan, this is, this is an article that came out on New

Corey:

Year's Eve, so I've kind of had this one in my pocket, but I've

Corey:

been wanting to bounce this off you.

Corey:

So you have not heard this article to my knowledge.

Corey:

Maybe you have, but if you have not, I wanted to read it to you,

Corey:

see what you thought about it, and we can kind of go from there.

Corey:

This was put up by Global News.

Corey:

Uh, a former BC drug user turned harm reduction and recovery advocate

Corey:

and an Alberta addiction physician are proposing governments pay

Corey:

some people to enter treatment.

Corey:

Guy Ella and Dr.

Corey:

Monty gosh said that the idea of incentivized treatment would see those

Corey:

who cannot access treatment through other means, including the homeless

Corey:

and those living below the poverty.

Corey:

Could be eligible for a small stipend of $20 a day to enter a 90

Corey:

day treatment program or facility.

Corey:

Six.

Corey:

The $600 a month would go into people's pockets and not towards food or

Corey:

accommodation costs, giving, giving them something to work with when they

Corey:

leave treatment and attempt recovery.

Corey:

And then it goes on a, a little bit of, um, into some of the specifics.

Corey:

Contingency management, gosh, gosh said, is a rewards-based system

Corey:

with incentives to get people into certain treatment programs That has

Corey:

been very effective for drugs like methamphetamines, cannabis, and alcohol.

Corey:

One of the big things that substance use hijacks is the rewards system of the.

Corey:

Pella, who spent two decades fighting homelessness and

Corey:

heroin addiction in Vancouver's.

Corey:

Downtown East Side is well aware of how a powerful motivator drugs are.

Corey:

He said that he's overdosed six times.

Corey:

Once Fentanyl hit the streets before he found a recovery through a safety net of

Corey:

harm reduction, compassion and suboxone.

Corey:

Drugs need to be counteracted with another catalyst, Ella and gosh

Corey:

said, monetary incentives work citing $5 in cash that convince dozens of

Corey:

downtown Eastside residents to get their COVID 19 vaccines in 2021.

Corey:

This is giving people confidence back and a little bit of identity that they too

Corey:

are a part of something that's bigger.

Corey:

So I guess my first question is how does that sit with you?

Corey:

$20 a day for a 90 day treatment program.

Corey:

To your knowledge with your background, would this be something that would, would

Nathan:

work?

Nathan:

I'm aware of the, uh, the, the one of the guys you're talking about there.

Nathan:

Mm-hmm.

Nathan:

guy, guy, uh, whatever his last name is there.

Nathan:

Um, I see him on Twitter quite a bit and he's definitely an advocate for getting

Nathan:

people to recover from drugs and alcohol.

Nathan:

That does seem to be something that he's pretty interested in.

Nathan:

And, uh, he's right about the motivation.

Nathan:

Factor as far as you know, they've done lots of studies like the, what

Nathan:

they did with the covid there, with the, uh, getting people to get a

Nathan:

shot for $5, but that's not the same.

Nathan:

It's not, no.

Nathan:

My first question would be, are they doing this for people who are already seeking

Nathan:

treatment or are they seeking to motivate people solely on a monetary basis?

Nathan:

Because I'll tell you right now, From what I understand about how motivation

Nathan:

works, when your brain is, uh, you know, if you're using a heavy drug,

Nathan:

chronically, we've talked about it before, you tend to be front loaded.

Nathan:

Mm-hmm.

Nathan:

. So what that means is you're.

Nathan:

Uh, executive function in your prefrontal cortex.

Nathan:

Uh, actually I just looked at a study the other day actually, that they've, they've

Nathan:

shown that dendrites start to retract in the prefrontal cortex and in a weird

Nathan:

twist dendrites extend in the amygdala.

Nathan:

in the nucleus accumbens and all the, uh, hip, uh, the, the areas that are

Nathan:

associated with, uh, memory and emotion.

Nathan:

So you can see how that's a double-edged sword.

Nathan:

Mm-hmm.

Nathan:

in front-loading the brain to a, we look at it as a now

Nathan:

versus, uh, future type mindset.

Nathan:

Right?

Nathan:

Yeah.

Nathan:

When you're doing drugs like that on a, on a regular basis, Normally the

Nathan:

human brain has a, a kind of level playing field where as an adult you

Nathan:

understand that delaying gratification is many times better in the long run.

Nathan:

Yeah.

Nathan:

We don't always do that, but that's, you know, that's, that's

Nathan:

kind of what a healthy brain does.

Nathan:

It's able to look at both options and make a, a judgment

Nathan:

call, and that's the part of.

Nathan:

Choice, I guess you could say that is affected by doing drugs on a

Nathan:

especially highly rewarding drugs on a consistent basis for sure.

Nathan:

It's not that you're unable to delay gratification, it

Nathan:

just becomes much harder.

Nathan:

So taking that as a kind of framework to work with and then.

Nathan:

using a small amount of money like that.

Nathan:

I mean, that's even a small amount of money to people

Nathan:

who are using drugs, right?

Nathan:

Yes.

Nathan:

Uh, it's not going to, $20 is like, that's a very mild, like you could get high

Nathan:

for $20 a day on, on meth and fentanyl.

Nathan:

It could be done, but you have to be a fairly new user, I think, to, to

Nathan:

be able to get by like that, right?

Nathan:

Mm-hmm.

Nathan:

, um, to my knowledge, Maybe, uh, you know, they, if they did studies and

Nathan:

uh, it would be interesting to see at what point, cuz you'd think there

Nathan:

would have to be a number, right?

Nathan:

, where if, if there was, you know, X amount of dollars presented to

Nathan:

get people to go to treatment, uh, they would probably say yes.

Nathan:

but it would, I think there'd be many people who would, uh, contrary

Nathan:

to what most doctors and a lot of advocates think that people would,

Nathan:

are able to delay gratification.

Nathan:

If they can see out the other side of that 90 days, and they're gonna get a

Nathan:

big chunk of ch change that they can use, they're gonna say, , okay, so

Nathan:

you're gonna feed me and you're gonna keep me off the streets for 90 days.

Nathan:

You're gonna pay me to listen to your, your program, or whatever.

Nathan:

and then I'm gonna get a bunch, bunch of money when I leave this place.

Nathan:

My concern would be, are we actually going to kill more people?

Nathan:

Mm-hmm.

Nathan:

. Um, because now you, you're giving them a, a bunch of money and they've been.

Nathan:

, you know, you've basically perfectly reset their brain for use.

Nathan:

Yeah.

Nathan:

That would be, 90 days would arguably be the most dangerous

Nathan:

time to give somebody money and send them on their way like that.

Nathan:

Unless the key thing would be what the initial motivation is.

Nathan:

Yeah.

Nathan:

You know, if they were motivated to do it themselves, and you are doing

Nathan:

that to give them a way of having a leg up when they get outta treat.

Nathan:

Then by all means, I think that's an excellent idea.

Nathan:

But it would all come down to what is the, what is the individual's motivation for

Nathan:

going to treatment in the first place?

Nathan:

And if you're trying to lure people into treatment with money, You better

Nathan:

have like a safety net set up on the other side to monitor for overdoses.

Nathan:

That would be my primary concern.

Nathan:

And then, uh, if you are gonna do that, uh, it, it's an excellent opportunity

Nathan:

for data collection, which is sorely missing from a lot of these things.

Nathan:

So, , that would be the, the two points I would make.

Nathan:

I mean, the guy's trying to do this in Alberta, that's

Nathan:

a, that's an uphill battle.

Nathan:

I can't see, I can't see, uh, any el like as far as getting money for

Nathan:

something like that, I would be shocked.

Nathan:

But we'll see.

Nathan:

I mean, I, I, is it something that's just been kind of proposed

Nathan:

or is it something that's gonna go forward, or what's the, to my

Corey:

knowledge, just proposed.

Corey:

I agree with you, Nathan, first, about the risk of actually setting

Corey:

people up for overdose on the other side when they come out.

Corey:

I think $600 a month is not, if we're looking at housing as being

Corey:

one of the primary issues, this is not gonna do anything for housing.

Corey:

$600 doesn't touch anyone's housing needs.

Corey:

In our province, we have, there are a lot of nonprofit organizations.

Corey:

There are underpaid social workers.

Corey:

And support staff of nonprofits and of government organizations.

Corey:

It's a fact that social workers are are hard, hard to find because

Corey:

they're not simply not paid enough.

Corey:

There's very little incentive for people to go in and stay in that industry.

Corey:

So we've now put people through this mandatory treatment and, and then what?

Corey:

You know, to me it's, when I think about the allocation of resources, allocation

Corey:

of money, I think I would rather see that go to ensuring that there are

Corey:

better support services and, and more social workers who are well paid for

Corey:

their many, many hours of hard work.

Corey:

Cuz I don't, I I think if we're gonna create a lasting change,

Corey:

that's what is, that's what is needed there among other, other

Nathan:

things.

Nathan:

Yeah, I'm not entirely sure what the angle is there.

Nathan:

Like what if, what $1,800 is meant to do, if it was coupled with like a

Nathan:

halfway house situation or something where there was some ability to

Nathan:

have access to enough housing to.

Nathan:

uh, you know, have a shower every day, and okay, here's some money to

Nathan:

keep yourself fed while you look for a job, or something like that, you know?

Nathan:

Mm-hmm.

Nathan:

, but just $600 per month on the other end.

Nathan:

That doesn't make any sense to me.

Nathan:

So maybe something's, you know, maybe they tend to do something like that.

Nathan:

And that's not, uh, mentioned in the story.

Nathan:

I mean, everybody's trying to do the best with, uh, with their perspective, I think.

Nathan:

And, and, and he, he seems like the type of guy whose heart is definitely

Nathan:

in the right place, but, It's, uh, it's a real tough one when you're trying

Nathan:

to incentivize people in that way.

Nathan:

I guess if you wanted to run a trial like that, I guess the, the easiest

Nathan:

way to do it would be, uh, make it scalable and start very small and you

Nathan:

must different differentiate between.

Nathan:

The people who want treatment and are actively seeking it

Nathan:

versus the people who aren't.

Nathan:

Yeah.

Nathan:

Otherwise you'll get no data.

Nathan:

That's useful.

Nathan:

And, uh, I think that if you did a cost benefit analysis based on, uh, even

Nathan:

a few of those, like a few trials of that type of program, you would find

Nathan:

that, like you said, the, in the end, the $600, because it's not just $600,

Nathan:

it's also 90 days worth of treatment.

Nathan:

which is gonna be, even if it's in Alberta, you're looking at, I don't

Nathan:

know, 40,000, something like that.

Nathan:

Mm-hmm.

Nathan:

. Mm-hmm.

Nathan:

. So that is gonna be an, yeah, I, I think that's gonna be a real tough sell as far

Nathan:

as the Alberta government's concerned.

Nathan:

I don't know if they'd even go for that here.

Nathan:

Yeah.

Nathan:

Because we can't even show results from people who are motivated to go to treat.

Nathan:

can do a 90 day treatment in a facility that's, you know, supposed to be high

Nathan:

end and they spend a lot of money for, and it's still , it still can be not

Nathan:

a, not a great success rate, right.

Nathan:

So mm-hmm.

Nathan:

, um, yeah.

Nathan:

Yeah, it's interesting.

Nathan:

I mean, I've never heard anybody trying to do that before.

Corey:

I also worry, you know, in reading, briefly reading through the

Corey:

responses that that article got like the.

Corey:

Comment section of Twitter below that article, it.

Corey:

And this doesn't make it a bad idea, but that very proposal is ripe for someone

Corey:

who is very critical of, of either social services or, um, money towards drug.

Corey:

Those who use drugs or harm reduction advocates.

Corey:

It, it's like dangling a , dangling a, the bait out there for, for that conflict.

Corey:

And I wonder if it.

Corey:

It feeds.

Corey:

An idea like that.

Corey:

And I'm all, I'm all for risk taking ideas or radical ideas that are

Corey:

gonna save lives and make a change.

Corey:

So it's not that, but like mm-hmm.

Corey:

that idea, particularly without the support, without flushing the idea

Corey:

out enough so that it has, so you have some of those safeguards and have.

Corey:

Have it as a, a trial with, with really carefully collected data and

Corey:

really carefully selected users to come into the trial and just like

Corey:

show that you're really putting all these pieces together to make it work.

Corey:

It just seems like it's ripe for, for criticism and more division and more

Corey:

mud slinging towards the drug using

Nathan:

community, I think.

Nathan:

Yes.

Nathan:

Yes.

Nathan:

You, you.

Nathan:

It's, it's so . It's so.

Nathan:

I don't know.

Nathan:

Like it definitely you could look for sources of income and, uh, you

Nathan:

could almost check for like, uh, you know, government involvement

Nathan:

to see if there wasn't some right wing , , Albertan, uh, premier or

Nathan:

rich person who is actively trying to, to make it the, the situation worse.

Nathan:

Yeah.

Nathan:

That, that is how that idea looks.

Nathan:

Yeah.

Nathan:

Because , it doesn't have, there's not a lot of chances for it to succeed versus

Nathan:

many disastrous problems that could occur.

Nathan:

That, again, I, I don't know.

Nathan:

You never know how a story is presented, especially coming outta Alberta.

Nathan:

It could be that they had the best of intentions, they did have safeguards in

Nathan:

place and they were thinking of that.

Nathan:

But, um, if you're not at least aware of, uh, of the dangers associated

Nathan:

with something like that, then I don't think you should probably be involved

Nathan:

in putting those ideas forward.

Corey:

Yeah, and you know, so the obvious comparison to me is like,

Corey:

Someone listening could say, well, how is that different than the idea

Corey:

of giving drug users free clean drugs?

Corey:

It's very different.

Corey:

It's very different.

Corey:

I mean, Well, one, you can directly measure the lives saved

Corey:

by someone who suddenly has access to a clean drug supply.

Nathan:

Yeah.

Nathan:

It's uh, com I mean, I don't see a more pragmatic common sense approach.

Nathan:

And the only argument against it, uh, other than the obvious political nonsense

Nathan:

would be, uh, is it cost effective?

Nathan:

Mm-hmm.

Nathan:

, and I would argue that yes, it is.

Nathan:

Because if you do the math on, you know, somebody who's already say they've

Nathan:

overdosed once, twice, whatever it may be, every overdose is very, very expensive.

Nathan:

Every hospital visit, every ambulance ride to stay a night in a hospital to recover.

Nathan:

Even if you get out that day.

Nathan:

there's a hefy, uh, price tag involved with that.

Nathan:

And that's just the overdoses.

Nathan:

That's not the physical injury that aren't, that doesn't turn out

Nathan:

to be registered as an overdose.

Nathan:

It's just a person is hurting badly and needs to go mm-hmm.

Nathan:

now they need to go see somebody at a walk-in clinic or, you know, there's

Nathan:

all these extra things that add up.

Nathan:

And if you eliminate those by providing drugs that are very, very, very cheap

Nathan:

to manufacture, then I think you.

Nathan:

, like again, it wouldn't be hard to do a small study to, to see what,

Nathan:

you know, you take, take a hundred chronic users, uh, who've had at least

Nathan:

one overdose, you could start there.

Nathan:

Mm-hmm.

Nathan:

, provide them with something cheap like, uh, diacetylmorphine,

Nathan:

heroine, or Hydromorph mm-hmm.

Nathan:

and see what happens.

Nathan:

Do it for a month.

Nathan:

Yeah.

Nathan:

You know, see how expensive it is to do that for a month versus how much of a, a

Nathan:

burden it takes off the healthcare system.

Nathan:

, and this is not, again, counting the police that are Yeah.

Nathan:

You know, we're trying to alleviate that, but, and on top of that, you have to, if

Nathan:

you're somebody who's in a situation where you're using a lot of illicit drugs, you

Nathan:

have to find that money somewhere and you need to account for the crime, so, mm-hmm.

Nathan:

you gotta take that amount of money that's being taken outta the economy.

Nathan:

You know, it's not just a, people need to understand that

Nathan:

it's, it's not just that you.

Nathan:

You're being altruistic and giving people money.

Nathan:

In a lot of these cases, I believe that it would actually

Nathan:

save us money in the long term.

Nathan:

Mm-hmm.

Nathan:

and people can't, they, it seems to be difficult for people to understand

Nathan:

that, but, and I could be wrong.

Nathan:

I could certainly be wrong, but to me it, it doesn't look even close.

Nathan:

I mean, no,

Corey:

I, and without, without fixing, The safe supply issue without fixing

Corey:

the toxic drug supply that is still on the streets like it has been

Corey:

for years now without fixing sort of our very clunky, dysfunctional

Corey:

mental health and healthcare system.

Corey:

Understaffed, overserved, putting someone through a treatment program for

Corey:

90 days to let their tolerance plummet.

Corey:

Yeah, I think it's a recipe for tragedy.

Nathan:

Mm-hmm.

Nathan:

. . I would take that deal if, I mean, if I was really in a bad place and I

Nathan:

was on the street, I'd take that deal just for the, the shelter and the

Nathan:

food and then I would say, fuck it.

Nathan:

Yeah, I'll use INS in at the facility too.

Nathan:

And you know, if they catch me, they catch me.

Nathan:

I, what are they gonna do?

Nathan:

Boot me outta the program.

Nathan:

I don't get my money.

Nathan:

Who cares?

Nathan:

I still, you know, like people are not idiots.

Nathan:

No, no.

Nathan:

So, I dunno.

Nathan:

Yeah, that's a , that's a pretty cool story to, uh, to bring up.

Nathan:

Interesting.

Nathan:

We'll keep our eye on that one.

Nathan:

Yeah.

Nathan:

Yeah, yeah.

Nathan:

Yeah.

Nathan:

, I'd love to hear a response from the, uh, from guy.

Nathan:

Well, from, from Guy i'd I, I'd be more interested in a response from

Nathan:

the Alberta government because, uh, I think that would be pretty funny.