“The business of America is business,” President Calvin Coolidge famously observed in 1925.
Plenty of other American cliches support his view: “Money talks, and (other stuff) walks,” goes one. “Show me the money,” says another. California authorities have now begun testing this principle on drug addiction, one of the state’s most obdurate problems.
If it works there, they also ought to try it on homelessness, where high percentages of the unhoused either refuse temporary shelter or end up back on the streets after getting thrown out of housing for various types of misbehavior.
The state’s ongoing trial run is a response to the failure of drug addiction treatment to respond to the many millions of state and federal dollars that have been thrown at it. The idea is to toss some of that money toward documented addicts of substances from heroin to cocaine, methamphetamines, fentanyl and other opiates and stimulants.
Deaths from these and related drugs quadrupled between 2011 and 2020, reports the California Health Care Foundation. Emergency room visits caused by amphetamine use rose 50% in just two years, from 2018 to 2020.
If addicts get highs from the drugs, one still unproven theory goes, perhaps they’ll be even more thrilled by receiving cash. Well, not exactly cash, but gift cards from a variety of retail and grocery stores.
These start with a $10 reward from Medi-Cal for the first clean urine test, rising steadily over 24 weeks to a total of $599, just below the $600 level at which income sources must be reported to the Internal Revenue Service and California’s Franchise Tax Board.
This is definitely throwing money at a big problem, about $50 million in mostly federal funds, but in a much more direct way than via psychotherapy and other current tactics. Today’s main treatment methods will not go away, nor will prescribed medications and counseling.
The idea of the money is to provide positive reinforcement, with material results for constructive behavior and the exercise of willpower. Authorities see this as a tool that might somehow “rewire” addicts’ brains to make them more interested in material well-being than immediate highs.
No one thinks cash-for-clean-tests can end drug addiction problems for everyone who suffers them. If it works on a significant percentage, though letting them sober up and stay that way for as long as 24 weeks, that would be progress and more than cover its costs by saving far more money in the costs saved on street crime and treatment.
And here’s that other idea: If cash can work for addicts, might it help the homeless? Many of them refuse to enter shelters because they want to remain free of rules and are not interested in counseling opportunities usually provided in temporary shelters like hotels now being rented or bought by cities and counties around the state.
How about giving them a no-strings-attached stipend, though, for each week they spend seven nights in temporary shelter? Maybe raise rewards a bit if they seek counseling and are observed to be taking treatment seriously.
If their acquaintances still on the streets see some of the unhoused getting food, shelter and money, some who now reject moving into shelters may become motivated to accept a temporary hotel room of their own, even if it means controlling their behavior at least enough not to get kicked out.
If this works and some of those involved move on to permanent housing or get jobs in today’s wide-open employment market, it would cost far less than the hundreds of millions of tax dollars now being spent for hotels and other temporary shelter.
There’s also the fact that drug addiction and homelessness often involve the same individuals. Helping them through one problem may contribute to solving the other. The peer-reviewed Journal of the American Medical Association has reported that 80% of studies of cash rewards for giving up use of stimulants showed they reduced drug usage at least somewhat.
In a way, this could be the ultimate test of the Coolidge observation about America. If money can’t dry out a significant portion of drug addicts and move major numbers of the homeless to inside spaces, it’s hard to see what else might.