This and Housing First are my favorite policy approaches to addressing addiction and recovery. It’s pure common sense that’s been repeatedly validated by empirical investigations in both conventional studies and pilot policies. It’s very difficult to imagine how you could oppose these unless you’re an armchair pseudoscientist, suicidally elitist, or a hack with an ulterior motive. Both directly increase recovery capital in ways that recipients repeatedly reinvest into themselves and their community as productive members of society.
Long-term outcomes of CM show that patients are 22% more likely to maintain sustained abstinence compared to psychosocial treatments like Cognitive Behavioral Therapy and 12-step programs. The standard factors associated with poor outcomes in psychotherapy, like a history of trauma or major depressive disorder, do not impact CM’s effectiveness. In fact the most severe and complex medical histories respond best to the simplicity and predictability of it.
Committed Mismanagement
It’s bizarre to me that a basic operant conditioning framework outlined by BF Skinner i
We’ve spent decades on disastrous policies rooted in the War on Drugs to satisfy our lust for punishment against those we felt were lesser than us.
We’ve spent billions on militarizing our communities to guard against the consequences of our children realizing that the generations above them didn’t care to leave a world they can see a future in.
Despite proposals from American doctors to treat addiction as a disease since before the ratification of the U.S. Constitution, including a signatory to the Declaration of Independence, we have been unable to move past the moralization of illness and healthcare.
Our most prominent peer recovery groups emerged out of deeply religious revivalist movements that connected drug use to the influence of the Devil and weakness of the individual’s will to resist sins.
We’ve poured billions into preventation education programs to “Just Say No” or “Avoid and Leave”, only to have them backfire on our kids and sometimes increase the use of drugs and violence in conflict resolution.
There is no economic reason for this; these approaches have been expensive and regressive failures. Some of our politicians take a deeply perverse pride in taking away the little capital retained by the poorest and most vulnerable members of their constituencies.
All this time, gift cards and basic housing accommodations would have done far more for far cheaper.
Notable Mentions
Hannah Pickard, What Would You Do Alone in a Cage with Nothing But Cocaine? (2026)
“Perhaps even more surprisingly given the dominance of the brain disease model, the most effective treatment for cocaine and some polydrug addictions is not pharmacological but behavioral. Contingency management treatment reliably delivers small rewards, such as prizes, money, and vouchers for meals or movies—or, in the behavioral psychologist Kenneth Silverman’s inspired innovation of a therapeutic workplace, skills training and employment—on condition of drug abstinence. It is based on operant conditioning principles, a form of reinforcement learning originating in the psychologist Edward Thorndike’s discovery of the law of effect at the end of the nineteenth century, and elaborated by B. F. Skinner in the 1930s and 1940s.”