Elias: California should try same test on homelessness as addiction

If cash incentives can keep people abstinent, perhaps they can keep those who need it in shelters.

“The business of America is business,” declared President Calvin Coolidge in 1925.

Many other American cliches support his point of view: “Money talks, and (other stuff) walks,” for example. “Show me the money,” another says. California authorities have now begun testing this principle on one of the state’s most vexing problems, drug addiction.

If it works there, they should try it on homelessness, where a high percentage of the unhoused either refuse temporary shelter or end up on the streets after being evicted from housing for various reasons.

The state’s ongoing trial run is a response to drug addiction treatment’s failure to respond to the many millions of state and federal dollars thrown at it. The plan is to direct some of the funds toward known addicts of substances ranging from heroin to cocaine, methamphetamines, fentanyl, and other opiates and stimulants.

According to the California Health Care Foundation, deaths from these and related drugs quadrupled between 2011 and 2020. Amphetamine-related emergency room visits increased by 50% in just two years, from 2018 to 2020.

One unproven theory holds that if addicts get high from drugs, receiving cash will make them even happier. Not exactly cash, but gift cards to various retail and grocery stores.

These begin with a $10 Medi-Cal reward for the first clean urine test and increase steadily over 24 weeks to a total of $599, just below the $600 threshold at which income sources must be reported to the IRS and California’s Franchise Tax Board.

This is definitely throwing money at a big problem, about $50 million in mostly federal funds, but much more directly than psychotherapy and other current approaches. Today’s primary treatment methods, as well as prescribed medications and counseling, will not disappear.

The money is intended to provide positive reinforcement in the form of material rewards for constructive behavior and the exercise of willpower. Authorities see this as a tool that could “rewire” the brains of addicts, making them more interested in material well-being rather than immediate highs.

No one believes that cash-for-clean-tests will solve all drug addiction problems. If it works on a significant percentage of people, allowing them to sober up and stay sober for as long as 24 weeks, that would be progress and would more than cover its costs by saving far more money on street crime and treatment.

And here’s another thought: If cash can help addicts, could it help the homeless? Many of them refuse to enter shelters because they want to be free of rules and are uninterested in counseling opportunities typically provided in temporary shelters such as hotels that are now being rented or purchased by cities and counties across the state.

But how about a no-strings-attached stipend for each week they spend seven nights in temporary shelter? Perhaps increase the rewards a little if they seek counseling and are seen to be taking treatment seriously.

If their friends who are still living on the streets see some of the unhoused getting food, shelter, and money, they may be motivated to accept a temporary hotel room of their own, even if it means controlling their behavior just enough to avoid being kicked out.

If this works and some of those involved move on to permanent housing or find work in today’s competitive labor market, it will cost far less than the hundreds of millions of dollars currently spent on hotels and other forms of temporary shelter.

Furthermore, drug addiction and homelessness frequently involve the same people. Helping them solve one problem may lead to the solution of another. According to the peer-reviewed Journal of the American Medical Association, 80% of studies of cash rewards for quitting stimulants showed that they reduced drug use at least somewhat.

This may be the ultimate test of Coolidge’s observation about America. If money can’t dry up a large number of drug addicts and move a large number of homeless people into shelters, it’s difficult to see what else can.