Incentives To Enhance Compliance With Addiction Treatment
Controversy and Compliance
From The Independent 1/26/2007
A draft of the formal guidelines for treatment of substance abuse by The National Institute for Health and Clinical Excellence (NICE) recommends that drug addicts receiving treatment should be given shopping vouchers, worth up to £10, if they adhere to treatment and tests indicate they are drug free.
According to this report, International trials have shown modest financial incentives can help hardened addicts stay off drugs.
Commentary
I’ve isolated the clinical essence of this story in the two preceding sentences.
Of course, the notion is not that simple. Most of the newspaper story, in fact, is given over to (1) anticipated resistance to the proposal (e.g., “The National Institute for Health and Clinical Excellence accepts that the idea is controversial”) and (2) justifications of the proposal beyond clinical evidence. In the latter category, NICE notes that the tactic would be cost-effective and that ” there would also be a public health benefit because addicts could also be screened for infectious diseases - such as HIV and tuberculosis.”
Just in case clinical evidence, cost-effectiveness, and incidental discovery and treatment of infectious diseases are insufficient defenses of gh plan, the Department of Health spokesman takes pains to point out that “This is not final Nice guidance to the NHS. It is a draft guideline for consultation and will be developed further in response to the comments received as part of the consultation” and “This is one of a range of approaches that may support better outcomes. These are potentially important suggestions that warrant further discussion.”
I am hardly disputing the accuracy of the presumptions implicitly and explicitly laid out in this news story. Many denounce use of public funds to deal with substance abuse as clinical rather than criminal matters. The idea of providing shopping vouchers to reinforce compliance for such treatment is sure to arouse criticism.
My fear, in fact, is that the proposal may be altered or attenuated and the possibility of political pressures overcoming good science is painful to contemplate.
My contention is that forgoing the use of incentives in this case, in which its advantages are clear cut is as dangerous to the healthcare profession as acquiescing to pseudo-populist community organizations who wish to forbid well-supported diagnoses and treatments proven effective (e.g., ECT for otherwise intractable depression) because of moral, cultural, or political convictions.
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