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

#treatmentincentive #rehabearnings #cashfornodrugs #treatmentideas

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

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

been wanting to bounce this off you.

So you have not heard this article to my knowledge.

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

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

This was put up by Global News.

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

and an Alberta addiction physician are proposing governments pay

some people to enter treatment.

Guy Ella and Dr.

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

who cannot access treatment through other means, including the homeless

and those living below the poverty.

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

day treatment program or facility.

Six.

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

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

leave treatment and attempt recovery.

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

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

with incentives to get people into certain treatment programs That has

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

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

Pella, who spent two decades fighting homelessness and

heroin addiction in Vancouver's.

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

He said that he's overdosed six times.

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

harm reduction, compassion and suboxone.

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

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

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

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

are a part of something that's bigger.

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

$20 a day for a 90 day treatment program.

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

work?

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

Mm-hmm.

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

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

people to recover from drugs and alcohol.

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

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

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

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

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

It's not, no.

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

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

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

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

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

Mm-hmm.

. So what that means is you're.

Uh, executive function in your prefrontal cortex.

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

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

twist dendrites extend in the amygdala.

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

associated with, uh, memory and emotion.

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

Mm-hmm.

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

versus, uh, future type mindset.

Right?

Yeah.

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

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

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

Yeah.

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

kind of what a healthy brain does.

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

call, and that's the part of.

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

especially highly rewarding drugs on a consistent basis for sure.

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

just becomes much harder.

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

using a small amount of money like that.

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

who are using drugs, right?

Yes.

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

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

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

be able to get by like that, right?

Mm-hmm.

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

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

would have to be a number, right?

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

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

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

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

are able to delay gratification.

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

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

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

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

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

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

Mm-hmm.

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

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

Yeah.

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

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

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

Yeah.

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

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

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

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

going to treatment in the first place?

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

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

That would be my primary concern.

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

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

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

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

a, that's an uphill battle.

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

something like that, I would be shocked.

But we'll see.

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

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

knowledge, just proposed.

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

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

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

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

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

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

There are underpaid social workers.

And support staff of nonprofits and of government organizations.

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

they're not simply not paid enough.

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

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

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

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

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

their many, many hours of hard work.

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

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

things.

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

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

halfway house situation or something where there was some ability to

have access to enough housing to.

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

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

Mm-hmm.

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

That doesn't make any sense to me.

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

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

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

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

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

to incentivize people in that way.

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

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

must different differentiate between.

The people who want treatment and are actively seeking it

versus the people who aren't.

Yeah.

Otherwise you'll get no data.

That's useful.

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

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

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

it's also 90 days worth of treatment.

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

know, 40,000, something like that.

Mm-hmm.

. Mm-hmm.

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

as the Alberta government's concerned.

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

Yeah.

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

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

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

a, not a great success rate, right.

So mm-hmm.

, um, yeah.

Yeah, it's interesting.

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

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

responses that that article got like the.

Comment section of Twitter below that article, it.

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

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

Those who use drugs or harm reduction advocates.

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

And I wonder if it.

It feeds.

An idea like that.

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

gonna save lives and make a change.

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

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

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

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

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

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

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

mud slinging towards the drug using

community, I think.

Yes.

Yes.

You, you.

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

I don't know.

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

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

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

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

Yeah.

That, that is how that idea looks.

Yeah.

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

many disastrous problems that could occur.

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

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

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

place and they were thinking of that.

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

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

in putting those ideas forward.

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

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

of giving drug users free clean drugs?

It's very different.

It's very different.

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

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

Yeah.

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

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

would be, uh, is it cost effective?

Mm-hmm.

, and I would argue that yes, it is.

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

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

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

Even if you get out that day.

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

And that's just the overdoses.

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

to be registered as an overdose.

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

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

all these extra things that add up.

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

to manufacture, then I think you.

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

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

one overdose, you could start there.

Mm-hmm.

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

heroine, or Hydromorph mm-hmm.

and see what happens.

Do it for a month.

Yeah.

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

burden it takes off the healthcare system.

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

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

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

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

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

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

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

You're being altruistic and giving people money.

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

save us money in the long term.

Mm-hmm.

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

that, but, and I could be wrong.

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

I mean, no,

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

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

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

mental health and healthcare system.

Understaffed, overserved, putting someone through a treatment program for

90 days to let their tolerance plummet.

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

Mm-hmm.

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

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

food and then I would say, fuck it.

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

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

I, what are they gonna do?

Boot me outta the program.

I don't get my money.

Who cares?

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

No, no.

So, I dunno.

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

Interesting.

We'll keep our eye on that one.

Yeah.

Yeah, yeah.

Yeah.

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

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

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