Thursday, November 1, 2012

Charging into Recovery – Is Cash Really a Gateway Drug?

By TRI David Festinger, PhD; Karen Dugosh, PhD; Ashley Harron | October 26, 2012 | 7 Comments | Filed in Addiction, Recovery & Treatment

A recent article published in numerous outlets announced the debut of a special credit card for recovering substance abusers.

The card, referred to as Next Step, purports to help addicts stay clean and sober by shielding them from the powerful cravings elicited by cash. The pre-paid credit card prevents the user from making purchases at liquor stores, bars, escort services, casinos, tattoo parlors, and piercing shops. It also restricts the user from making ATM cash withdrawals or receiving cash back when making purchases. The article extols the virtues of the card and refers to cash as a “gateway drug” and a trigger for substance use.

Although the field of addiction treatment is always in need of new ideas and helpful tools, it is critical that the ideas/tools be based upon sound research. The idea that “cash in hand” is a trigger for drug use has long been an area of critical debate. Common sense suggests that cash, which is used to purchase drugs, “must” be a precursor and trigger to substance use and relapse.

However, research has found limited support for this common belief. Although some research has linked the occasional receipt of large sums of money to relapse, most studies indicate that individuals who receive money while in addiction treatment use the cash for daily necessities such as bills, food, transportation and household items. Our own program of experimental research (Festinger et al., 2005; Festinger et al., 2008) as well as research conducted by Dempsey et al. (2008) and Vandrey et al. (2007) found no connection between cash payments as high as $160 and new drug use. In fact, this was true even for individuals who were no longer enrolled in treatment.

Addiction treatment, and relapse prevention more specifically, typically focus on avoiding triggers such as old neighborhoods, substance abusing friends and items associated with prior substance use. The use of cash in our society would make long-term avoidance of it highly unlikely. Even assuming that cash on hand is a threat, the use of these specialty credit cards in the short term means that recovering individuals would not be exposed to cash until they are potentially out of treatment and have less structure and support. Either way, use of these new “drug-free” cards has very real and substantial costs. Their fees, admittedly among the highest in the market, stand to cause more harm than good as they further an unfounded assumption based upon the overly paternalistic view that people who suffer from addiction cannot be trusted with money. Equally interesting are the behaviors that the card company chose to restrict. Tattoo parlors and piercing shops must also have a well-documented link to relapse. Surprisingly there was no mention of limiting card purchases on rock or rap music.

Policies and programs like this one are based upon isolated events, individual observations and broad generalizations rather than empirical data. There is no doubt that individuals who abuse drugs most often use cash to purchase drugs. But they also use their feet, bikes, cars and other forms of transportation to meet their dealers. Should we enforce transportation limits on them as well? Are cars a gateway drug? Research to date indicates that cash is not, despite case examples and anecdotal reports, a major trigger to relapse.

Learning how to live with and use cash responsibly should occur as part of treatment and not come at an additional cost to those already struggling to rebuild their lives.

The writers are members of the Section on Law & Ethics Research at the Treatment Research Institute (TRI). TRI is a non-profit research and development organization dedicated to developing and providing evidence-based solutions to the problems of substance use affecting families, schools, businesses, courts and healthcare. To learn more, visit the TRI website.

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