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To stop or start?

Posted in Law + Social Policy, Science + Health by expresscheckout on 11 June, 2008

Voucher incentives for drug users
June 11, 2008
BBC News

Drug users are to be offered vouchers for things such as gym membership and to pay utility bills to encourage them to comply with treatment programmes.

The National Treatment Agency in England is piloting the incentive scheme at 15 sites starting this week. It will be the first time incentives have been used in such a way. Drug addicts will be awarded vouchers – limited to £200 over the 12-week pilot – for staying drug-free, attending clinics and for getting health care. The care option is designed to get drug users to take tests for hepatitis B and C, HIV and TB as well as receiving treatment.

The NTA has acted after NHS advisers, the National Institute for Health and Clinical Excellence, recommended the approach last year. Such schemes have been used in the US with research showing participants stay drug-free for twice as long as those not taking part in incentive schemes. The pilots in England, carried out in partnership with the NHS and voluntary sector, will allow users to “earn” vouchers worth between £2 to £4 for achieving goals. As the pilots progress, the amounts they can earn will increase.

But most participants will be able to get will be £200 and they will not be allowed to spend the vouchers on alcohol or luxury consumer goods or exchange them for cash. Instead, participants will only be allowed to spend them on agreed items such as evening classes, transport or utility bills. One pilot is limiting the rewards to luncheon vouchers. Improving the effectiveness of treatment programmes is a key plank of the government’s drug strategy which was launched earlier this year.

‘Stable lives’

Public health minister Dawn Primarolo said the pilots had been designed to help users lead more “stable lives”. “The trial will be fully evaluated to see whether or not it could be implemented nationally.” NTA clinical adviser Dr John Dunn added: “We are applying the tried and tested principles of a basic behavioural rewards system…In the case of drug users, encouraging a very small change can have life-saving consequences.”

“This new approach is a way of kick-starting change and helping people regain control over their chaotic lives, thus reducing the harm done by their drug use to families, neighbours and communities.” But a spokesman for DrugScope sounded a note of caution. “In principle an incentive scheme is to be welcomed. But we would be concerned if incentives were used by poor-performing treatment services to mask problems and hit government targets.”

Scepticism

A clinical psychologist who worked in NHS drug treatment services for 10 years until recently said: “I am very sceptical about this…This is another political exercise to prove to the public at large that certain numbers of people are in treatment and attending appointments – but it’s not an indication of whether drug treatment is working in the long term…I simply don’t believe that giving any incentive is a real indicator of people changing their behaviour and stopping using drugs.

“I have seen the NTA introduce more demands, paperwork and statistics at the cost of patient care…My nursing colleagues were covering dangerously high workloads of extremely unwell people. Some nurses have caseloads of nearly 50 people – you can’t as a single person be expected to do a good job for that many people with such complex needs.” The Welsh Office said it was interested in persuing a similar scheme.

See also: DrugScope

National Treatment Agency