Encouraging Abstinence Behavior in an Opioid Epidemic: Incentivizing Inputs and Outcomes

Combating the rise of the opioid epidemic is a central challenge of US health care policy. A promising approach for improving welfare and decreasing medical costs of people with substance use disorders is offering incentive payments for healthy behaviors. This approach, broadly known as “contingency management” in the medical literature, has repeatedly shown to be effective in treating substance abuse. However, the use of incentives by treatment facilities remains extremely low. Furthermore, it is not well understood how to design optimal incentives to treat opioid abuse. This project will conduct a randomized evaluation of two incentive schemes for people with opioid use disorders, one incentivizing “inputs” to abstinence, and one incentivizing the “outcome” of abstinence. Both schemes are implemented with a novel “turnkey” mobile application, making them uniquely low-cost, low-hassle, and scalable. Effects will be measured on abstinence outcomes, including longest duration of abstinence and the percentage of negative drug tests, and the persistence of the effects will be assessed. In combination with survey data, variation from the experiment will shed light on the barriers to abstinence more broadly and inform our understanding of optimal incentive design.