Surviving Opioids - Beyond an Epidemic
Surviving Opioids - Beyond an Epidemic
Pay to Play? California Discusses Paying People to Stay Sober
A story came out last week about California trying to become the first state to incentivize people financially to stay sober.
Story here
Most people who complete the treatment without any positive urine tests during a set period of time will get a few hundred dollars put on a gift card. The governor calls it “contingency management,” and he wants it to be paid through Medicaid.
The bill already made it through the democratic-lead senate without opposition, and now it’s pending in the assembly.
All told the public cost would depend on the number of people participating, but it’ll be less than 1 million dollars which isn’t much compared to their 250 billion budget.
Since Medicaid would be the organization likely paying for it, what they’re debating in California is whether state law allows something like this to be paid for, and then even if the state itself can change the law, they’ll have to figure out whether or not it violates federal law.
In this episode, I go over some of the details of the bill, give my own perspective on the discussion, and share a few personal stories.
Follow on Instagram at Reaction Recovery for more daily topics, and please share this with a friend if you like the topics.
California looks to become the first state to pay people to stay sober. Overdose rates have been out of control the past few years, California is getting hit hard, not just opioids, but stimulants too, and policy makers are getting creative… So what’s this new proposal all about and will it work? We’ll get into all of it right now…..
Welcome to the Surviving Opioids – Beyond an Epidemic – Podcast – your one stop show for everything opioids, addiction, and recovery. I’m your host Jeff Simone. The purpose of this show is to hear from all different voices on the opioid crisis, and to give a perspective on certain topics that might be a little different than you’re used to hearing.
It’s a show to remind you that although we’ve lost a lot of good people the past couple decades, we also do recover. Through establishing community, slowly changing our daily behaviors, addressing underlying conditions, and holding each other accountable, we can get better.
Recovery, not merely temporary abstinence, is possible.
If you enjoy the episode, give it a rating, share it with someone, and keep the conversation going. Alright guys, enjoy the episode……
Okay maybe you’ve heard maybe you haven’t, a story came out last week about California trying to become the first state to incentivize people financially to stay sober…
And its not going to be millions of dollars or something, but what theyre saying is that most people who complete the treatment without any positive urine tests during a set period of time will get a few hundred dollars put on a gift card…. The governor calls it “contingency management” and he wants it to be paid through Medicaid.
The bill already made it through the democratic-lead senate without opposition and now it’s pending in the assembly.
All told the public cost would depend on the number of people participating, but it’ll be less than 1 million dollars which isn’t much compared to their 250 billion budget.
Like if there are 1000 people enrolled that complete the treatment and they get $300/ea, well that’s $300,000 for the state, so we’re not talking about huge amounts of money against the budget.
But since Medicaid would be the organization likely paying for it, what they’re debating in California is whether state law allows something like this to be paid for, and then even if the state itself can change the law, they’ll have to figure out whether or not it violates federal law.
So those are the kinds of things they’re talking about now…
But either way, if California state passed it, which it probably will, then it would just make it legal statewide and from that point each of the different counties could make their own decisions about adopting it for themselves.
That’s the basics of it… an important point right off the bat is that we’re talking about maybe $100/month sort of thing over say 3 months. So its not necessarily the amount of money that’s the big deal but it’s the fact that it’s a little something extra to motivate someone in the beginning when things tend to be extremely touch and go there for a little while…
Ask anyone who’s gotten sober, there is this feeling early on that this sobriety thing might actually take and maybe I can do this, but also I might completely fall off the rails 10 mins from now and things could be worse than ever.
And look, also, what is the chip system at a 12-step meeting if you really think about it? It’s a little extra motivation and specialness given to those early months. For example, we’re not giving out chips for 31 months, and 32 months, and 33 months, no we’re giving them out for 1 month, and 2 months and 3 months, and theres no doubt in my mind that there are times when someone is on shaky ground, maybe they have 5.5 months and just the thought of wanting to pick up that 6 month chip pushes them through that day, then tomorrow they wake up feeling a little better.
So I sort of see it like that…. Like if you’re on day 16 sober, and you’re having cravings, but you know that tomorrow morning you’re gonna be tested and if you pass, you get $100, well that might be enough to just push through the night… and in that case, you could quite literally be buying someone an extra few hours of sobriety…
Now is this the end all tell all solution to the addiction crisis? No, of course not and no one is suggesting that it is.
Does the ultimate motivation to recover need to come from within and can’t be bought or bribed out of someone? Yes, of course, but that is not what this is… These would be very short term, little incentives to keep going during those initial hours and days.
And obviously when these stories come up, just the way that theyre presented in the media, the headlines are written in such a way to intentionally drum up controversy and debate… and so you’ll predictably get the brilliant know it all recovery zealots coming out of the woodwork chiming in how this wont work and you need to WANT it and all this, and they’re right, long-term, yes, it has to come from within eventually… but the problem is it is very hard to get to long-term if you cant make it past short term.
Like I was just saying, its such a touchy, delicate few days and weeks there in the beginning where you could be feeling great at 10AM on a Monday morning then be off the rails by noon.
I’ve told this story before, I don’t think on the podcast though. After my first relapse in 2013, I went through another detox in the middle of 2014, and there was this few month period where I was back and forth in and out of the 12-step rooms, and I’d be doing well for a couple weeks then fall off and it went like that and a lot of good people were trying to help me.
And I went to this noontime meeting, it was a Tues afternoon or something, it was a mens meeting right on the promenade and just a room packed with awesome sober dudes, and a bunch of people came up to me after the meeting, and I felt really good, and I had gotten dropped off there but it was nice out like it usually was in Santa Monica, so I decided to walk home to my apartment which was about 20 mins away, and somehow from the meeting to my apartment, somewhere in there I decided I wanted to get high, and I texted my guy, and by the time I got back, I walked right into my car and drove out to West Hollywood where I used to meet up with this guy.
This guy was a character too, actually a really nice guy, just happened to be a drug dealer, he had just gotten out of jail so he was super paranoid about everyone, definitely me at first, also I didn’t really look and sound like the other people he was dealing with so a lot of people used to be unsure about me for a while… he would have me meet at a 7-11, then when I got there, I would call, then he would tell me a different 7-11 to go to, and I had to get there in 5 mins or else he would leave…
And I never really questioned stuff like that, it was just… whatever. Like I never argued with anyone, those terms were just his terms, they were just a means to an end.
This is also the guy who taught me, “when in doubt, go without.” It’s a drug dealer’s spin on the famous big book line – pause when agitated or doubtful.
That actually saved me from a bunch of questionable situations… When in doubt, go without…
But anyway I’m getting off topic here, I’ll save ‘wisdom from a drug dealer” as a topic for another episode.
So anyway, the point of that story is how quickly I went from being at a great meeting and talking to good people and feeling motivated and enthusiastic about sobriety to kicking off one of the worst month-long runs of my life.
How someone feels in those early days one minute has no correlation to how theyre going to feel the next minute, and especially if we’re talking about situations where the person isn’t confined by a safe rehab setting or something like that, any kind of little motivators are good.
In terms of the research with this type of approach, there was an analysis done by the California Health Benefits Review Program into offering financial incentives like that, and that review concluded that there is “clear and convincing evidence that it helps keep people abstinent from drugs like methamphetamine and cocaine during the program, but that the effect doesn’t last much beyond six months after treatment concludes.”
And that’s pretty much what I would predict …– that something like that can be a small motivator early but any type of benefit would wear off quickly, which seems to be what the research showed too – again, specifically with the stimulants…..
So I’ve read a few articles about this, and I read some of the social media comments , and I’ve been hearing sober people in the recovery community saying things like “All I would do is just collect the money over those couple months then just go out on a huge bender for a few days.”
You know, sometimes I feel like the recovering addicted people really do forget what things were like…. First of all, we’re talking about around $100/month… So you’re telling me that you could white knuckle through 3-6 months of sobriety for a few hundred dollars total just to go out on a bender after that?
That sounds like a horrible trade off if you’re going into the whole thing thinking that way… Like youre telling me you couldn’t just keep right on using and hustle more than $100/mo?
Of course you could so it really isn’t about some lifechanging amount of money, it’s simply about the initial incentives – which like I said, is kind of what chips are for in my opinion.
Just a fun little something to look forward to when you’re right over the fire during those early days.
Also, it’s always important to keep in mind, that nothing seems to be having huge effects, and we’re doing badly across the board, so an administration or a policy team that continues to offer new attempts needs to be listened to.
From my own perspective, there really aren’t too many, if any, major policy changes to addiction treatment that I’m opposed to these days…. And it’s taken me a while to get to that point…. It’s like I say a lot, the best and sometimes worst thing for the recovery community are people with long-term continued abstinence…
on the one hand, it’s great for motivation and hope and guidance and giving new people a vision of what could be, and on the other hand, we tend to get very self-righteous about our own recovery (even though we sometimes think of ourselves as super humble people).
But a lot of us get trapped behind the vale of “If I could do it, you can do it.”
And even though there’s truth that recovery is available to everyone, that alone cant be a defense to block any other attempts to mitigate suffering or lessen distress.
I’ve used the example of pancreatic cancer before. It’s a good example because the long term full recovery rates are similar to serious drug addictions – around the 3-5% mark for full recovery, but 3-5% is not zero.
So there are cases of spontaneous recovery like there are with any chronic progressive illness, but that would never be a reason to deny the other 96% of people treatment options.
Like I don’t know what the annual incidence of pancreatic cancer is but lets say on any given year 500 people somehow fully recovered from that diagnosis.
Well you wouldn’t expect these 500 people to get together and start meetings where they’re telling everyone else, “don’t worry about what those doctors are saying – all that chemotherapy crap and radiation, that stuff doesn’t work, if you need any proof just look around the room, there are 500 people here who got better and they’re doing great now, and if we didn’t need any of that kind of stuff, then neither do you… So remember newly-diagnosed pancreatic cancer sufferers, if it worked for us, it can work for you.”
Clearly that would be a problem and thankfully there aren’t groups like that, and the analogy doesn’t line up perfectly but its an illustration of how arrogant and potentially harmful that type of messaging could be….
And you’ll see it a lot, any type of new strategy or approach immediately getting laughed at and mocked by the recovery community…. But I do understand it, because I did used to be that way…. And I was one of the mockers and the scoffers, but I just look at things differently now/
Also, when one state starts trying things like this it usually creates a cascade effect.
Like when Portland passed measure 110 – I put out an IGTV video a few days later where I said it’s probably not going to have much of an effect locally, at least not for a while, but it’s a huge step in the right direction because it’s offering a new narrative and a new way to look at the problem.
Well that’s kind of what this is. Just another statement from our leaders to addicted people that we care about you and don’t think you’re bad people. And were not just going to penalize you and punish you forever like we used to, we’re actually trying to do things….
For example, consider the same situation but for a group of people that are still shunned for their immoral behavior… Like imagine there’s a group of serial pedophiles, and we release them all from prison, and then your state passes a law that for every month that we don’t catch them molesting little kids, we put a couple hundred dollars in their bank accounts…..
Well, I think that story might get a little bit of news attention. But Why? Because there is a stigma against the behavior of pedophilia, and just about everyone agrees that we need to remove these people from free society for the safety and protection of everyone… And we cant in good conscience give someone money just because they haven’t partaken in some terrible behavior.
Just like we wouldn’t pay a bank robber for each month that he doesn’t commit armed robbery.
Or an arenist for every month he doesn’t light a house on fire.
Well for many years we put personal drug use in the same categories as those other things…. But it doesn’t belong in that category. Not the drug use itself.
When we talk about morality and rights, we’re talking about interpersonal rights not intrapersonal rights.
Theres a saying that goes “your right to swing your arms ends where my nose begins.”
So yes, we may live in a free nation where I can stand in place and make punching motions with my arms, but if someone is in front of me, and I refuse to stop, and I punch them in the face, well I’ve just lost my right to swing my arms so now morality comes into play and then consequently the legal system comes into play.
If a drug addicted person uses drugs and then burns your house down, well there needs to be consequences for that, otherwise society will devolve into anarchy.
But if a drug addicted person uses drugs and isn’t bothering anyone or infringing upon their personal rights, the issue of morality needs to be removed from the conversation (soft) .
So if we hear a story like the state is looking to pay people to stay sober, and we have a strong reaction of disgust or self-righteousness, well we should look into that…
(slower) Another point, and I’ll wrap this up because I want to keep it short is that a lot of this focus is to reduce the overdose deaths from stimulants in particular, which has quadrupuled in the past 10 years, particularly from methamphetamine.
Some of it has to do with those products getting laced with fentanyl too like everything else, but mostly it was just due to the increase in stimulant use itself.
So whereas the state does encourage opioid-replacement strategies for a lot of the heroin/pain-killer addicted folks, theres not many good treatment options for the stimulant users, and it’s very well documented that keeping someone abstinent from methamphetamine or crack cocaine early on during or right after treatment is very hard.
So this contingency management proposal…. It’s just a strategy that they’re going to try out since not much tends to be too effective (out)
Alright, that’s my brief overview of the facts and some personal insight into it….
Is paying someone to stay sober going to solve the addiction crisis, no of course not. But could it help be a tiny motivator in the beginning that might help someone eek past those first couple weeks? Possibly, we’ll see.
It’s a small proposed investment, its not going to change your life as a taxpayer in any way, and I think if you’re having a strong reaction to the conversation, you should take a few minutes and look into why you’re feeling that way.
Alright guys, that’s it for today. Reach out on Instagram at Reaction Recovery for more daily topics and share this with someone if you think theyd like it… Talk soon.