NIDA – Publications – NIDA Notes – Vol. 21, No. 6 – Research Findings
A new intervention enhances prospects for substance abusers whose mental illness complicates the path to recovery. In a recent clinical trial, a 6-month course of Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness (BTSAS) reduced drug abuse, boosted treatment-session attendance, and improved the quality of life of outpatients with a wide spectrum of mental disorders.
Dr. Alan S. Bellack and colleagues at the University of Maryland School of Medicine in Baltimore designed BTSAS to counter the factors that make recovery from addiction especially difficult for people who have co-occurring severe and persistent mental illness. These factors include frequent failure to meet their own and others’ expectations, inconsistent motivation, and social and personal pressure to appear normal.
Twice-weekly sessions begin with urine tests. Patients who have provided drug-free urine samples are praised by the therapists and group members. They also receive financial incentives that start at $1.50 for the first drug-free sample and increase in $0.50 increments for every consecutive one thereafter, up to $3.50. The amount is set back to $1.50 after a drug-positive sample or an absence.
The researchers reported that the extra costs of running the BTSAS program were modest. For the 6-month trial, monetary rewards averaged roughly $60 per patient; total per-patient cost, including therapist time, was $372.
“Let’s see, I need to pass a pee test twice a week so I can make sixty bucks. Now that marijuana is relatively expensive, and if I use it then I could test positive for two to four weeks. But the crack and the meth, those are real cheap, and if I use some of those after my Thursday test, I’m pretty sure I can clean up in time for my Monday test, since those drugs flush out in just a couple of days. I suppose I could just get drunk as well, that’ll clean out pretty quick and it’s legal….”
I am completely in favor of more drug rehabilitation and treatment for addiction and for the mentally ill. A drug treatment center saved my dad’s life.
But any time you bring urine testing into the equation, you create an artificial incentive to stop the safest drug, marijuana, in favor of the harder, less detectable drugs. Also, an addict’s recovery needs to be something that is built from within, not incentivized with petty bribery.
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