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Field
Abstract
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Before
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 opioid abuse. 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. Effects will be measured on abstinence outcomes, including
longest duration of abstinence and the percentage of negative drug tests. 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.
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After
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 opioid abuse. 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. Effects will be measured on abstinence outcomes, including longest duration of abstinence and the percentage of negative drug tests. 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.
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