Encouraging Abstinence Behavior in a Drug Epidemic

Combatting the rise of the opioid epidemic is a central challenge of U.S. health care policy. A promising approach for improving welfare and decreasing medical costs of people with substance abuse 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 substance use disorders. This project will conduct a randomized evaluation of two types of dynamically adjusting incentive schedules for people with opioid use disorders or cocaine use disorders: “escalating” schedules where incentive amounts increase with success to increase incentive power, and “de-escalating” schedules where incentive amounts decrease with success to improve incentive targeting. Both schemes are implemented with a novel turnkey mobile application, making them uniquely low-cost, low-hassle, and scalable. We will assess impacts on abstinence, measured as the percentage of drug tests that are negative for illicit opioids and cocaine, and on a self-reported metric of quality of life. Variation from the experiment will shed light on the barriers to incentive program implementation while informing our understanding of optimal dynamic incentive design.