SALT LAKE CITY — In California, gang leaders who transform into peacemakers are being rewarded with money. In Salt Lake City, people struggling with cocaine addiction can win prizes for a clean drug test.
Some people call these incentives; others say they’re a bribe. But governments looking to get people to behave in a certain way are increasingly giving out cash.
The city of Boston recently gave every incoming kindergartner $50 in a savings account to nudge families to start saving for college. Vermont is paying people $10,000 to move there. The principles behind these policies may also be on display in your own family, if you pay your children for good grades or let them earn dessert by eating their broccoli. If you want to get people to do something, so the thinking goes, dangle a reward in close reach.
But not everyone is a fan of this system. Researcher and scholar Alfie Kohn, the author of “Punished by Rewards” and other books, argues that “carrots,” or incentives, can be just as counterproductive as sticks.
“Both are forms of manipulation, and neither can produce anything beyond temporary compliance,” Kohn says.
Then there’s the problem that paying people not to do bad things is more ethically fraught than simply rewarding them for an accomplishment.
But supporters of incentives say there is ample evidence that the system called “contingency management” works, including a study published Oct. 2 in the American Journal of Public Health that attributes a decline in gun-related violence to an incentive-based program in Richmond, California. And the administrator of a program that rewards Salt Lake City veterans for having a clean drug test say the program is effective and both employees and veterans love it.
Is there a wrong way to get people to do the right thing? Or is it smart public policy to use the brain’s natural craving for rewards to enforce good behavior?
An ‘allowance’ for gang leaders
When the city of Fresno, California, was considering whether to fund a program designed to cut down on gun violence, California congressman Devin Nunes tweeted that it was another example of his state “going off the rails ... paying criminals to be nice.”
In fact, cash payments to people prone to violent behavior is just one component of the “fellowships” offered by a nonprofit called Advance Peace, said DeVone Boggan, the founder and CEO.
The group aims to reduce urban violence by identifying leaders at the center of violent activity in a community, and offering them an 18-month “peacemaker fellowship” that includes mentoring, daily check-ins, internship opportunities, goal-setting, travel and, most controversially, a cash allowance of up to $1,000 a month, after the first six months, when goals are met.
In Richmond, where Advance Peace is based, the city saw a “significant” reduction in firearm-related violence, including 55% fewer deaths and hospital visits and 43% fewer crimes, after the fellowship program was established, according to a study published this month in the Journal of Public Health. The authors said “these associations were unlikely to be attributable to chance.”
Advance Peace calls the payment an “allowance” and does so deliberately, in keeping with the goal of creating a healthy, protective environment, like a family, for the men participating in the fellowship, Boggan said. “My children receive a weekly allowance, as do most of their peers … and also sometimes a celebratory allowance when they’ve done well, to show them that they’re valuable. That’s what this about. I want to make sure that these young men — most are young men — get everything my children get.”
He also noted that the men have to earn the money by meeting goals, which are often difficult for these men, “some of the most lethal in the community,” to achieve. The fellows set their own goals, with the help of mentors, such as obtaining a driver’s license or Social Security card, going to cognitive behavioral therapy or anger management classes, paying child support, saving a set amount of money, and creating a peace agreement with rivals.
In the organization’s inaugural program in Sacramento, where 106 fellows are in month 16 of an 18-month program, “We haven’t paid one allowance yet. You have to earn it,” he said.
Even when the stipends are paid, Boggan says the cost to the city is much less than the cost of deadly gun violence gone unchecked. Still, not everyone is comfortable with the idea. Fresno’s City Council allocated $200,000 for the program, but the expenditure was later vetoed by the mayor.
Stay clean, win a prize
Whenever “contingency management” comes up, there’s usually a reference to the research of the late Nancy Petry, a psychologist and researcher at the University of Connecticut who died from breast cancer in 2018.
Petry’s husband, Dr. William B. White, is a cardiologist, now retired, but he often worked with his wife on incentives to improve health outcomes. Petry saw physical rewards as a way to counter impulsive behavior that led to addiction, whether it be alcohol, cigarettes or drugs. Her work paved the way for the Veterans Administration to implement incentives in its treatment for people struggling with substance abuse.
Petry’s method was simple. She would put slips of colored paper indicating a prize in a fishbowl, “literally a fishbowl,” White said. “Turned out, there was a certain kind of person that got excited about the chance of winning a prize, whether it was toiletries, or gas for your car or gift cards for food.
“Throughout her career, she used this method but would adapt it according to the problem and the person,” he said. For example, cash wasn’t a good prize for people struggling with substance abuse, since they might spend it on drugs or alcohol. But cash prizes worked well for adolescents and teens who needed, for example, an incentive to take medication for diabetes. And the prize didn’t have to be expensive to be effective, he said.
In Salt Lake City, the VA has two incentive-based programs. The first, begun in 2016, allows people in recovery from stimulant abuse (including methamphetamine, cocaine and similar drugs) to choose a token from a bowl every time they have a clean drug test. Not every token gives them a prize; some just say “Good job!” But others can be redeemed for small or large prizes, and people can save tokens to get a larger reward, said Heather Pierson, program manager for the VA’s Services for Outpatient Addiction Recovery, or SOAR.
Another program, begun six months ago, offers the same system of rewards to veterans battling opioid or alcohol abuse. In this program, however, they earn tokens for coming in to receive a naltrexone injection on schedule.
White said his wife was aware that some people found it unethical to give prizes to combat something as serious as drug addiction, but her answer was essentially, “Why not?”, especially when it worked. And, he noted, the National Institutes of Health didn’t believe there was anything wrong with the practice; “that’s why she kept getting funded every year,” he said.
He said that a study is now underway on the effectiveness of using prizes to combat video game addiction. “There is no treatment for that; there is no medication. What do you do?”
The investigators continuing Petry’s work are thinking the answer might be to offer teens cash to turn off their screens.
People aren’t pets
One of the biggest critics of rewards-based programs is Kohn, the Massachusetts researcher and author whose 1993 book “Punished by Rewards” eviscerates the practice of using gold stars, praise “and other bribes” to reward children for good behavior or performance. “We take for granted that this is the logical way to raise children, teach students, and manage employees,” Kohn wrote in the book, which was recently re-released for its 25th anniversary.
But Kohn says a “do this, and you’ll get that” system is “profoundly wrongheaded” because it is based on control.
“Rewards are ultimately about power; the people with power are using them to try to control people with less power,” he said in an interview.
“Study after study after study finds that these programs, at best, do not have a lasting effect, and more commonly, actually make things worse than they were to begin with.”
For example, one study of adolescent girls in the 1990s found that their grades and attendance were worse than their baseline after rewards were withdrawn, he said. “People might want the reward itself; they might like the money or the grade, but on some level, people don’t like being treated like pets, and that’s exactly what these programs are about. They’re about control, and people don’t like being controlled.
“The only thing you can get from a reward or a punishment is temporary compliance, but usually at a significant cost.”
While Kohn considers rewards the “flip side” of punishment, Jan Kubanek, an assistant professor at the University of Utah who has a doctorate in neuroscience, has participated in research that found that punishments are more effective than rewards in inducing behavior.
The study, done at Washington University in St. Louis in 2015, showed that people were two to three times more likely to take an action to avoid the “punishment” of losing a certain amount of money than they were to gain the same amount of money.
From an evolutionary perspective, this makes sense and could be encoded into our brains. Finding a field of grapes, an example of a chance reward, is nice, but not finding one doesn’t necessarily threaten our survival, like encountering a hungry carnivore would, Kubanek said.
While the study was small, consisting of just 88 people, there was a “quite striking” takeaway, Kubanek said: “People learn from punishment more than rewards.”
A program that worked
White, and other proponents of incentive-based programs, however, cite recent research that suggests contingency management works. A national review of 94 VA programs that implemented prizes for clean drug tests between 2011 and 2015 — the largest such initiative ever undertaken on contingency management — found that nearly 92% of 2,060 patients who participated tested negative for prohibited substances.
Participants had the opportunity to be tested, and potentially earn a prize, twice a week. As in Petry’s original research, they drew from a fishbowl containing 500 slips of paper that could contain one of four options, only three of which would result in a prize.
Some of the slips simply said “Good job!” Others indicated that the person won a small prize (value of $1), a large prize ($20) or a “jumbo” prize, worth $100. But there was only one “jumbo” in the bowl, and only 40 chances to win a $20 prizes. Prizes were replaced after a drawing, so the chances remained constant, however, the participants were not informed of the odds.
“This reinforcement system consistently yields benefits with respect to reducing substance use at relatively low costs, with average earnings under $200 per patient over a 12-week course of treatment,” the authors of the study, which included Petry, wrote.
White, the Connecticut cardiologist who was married to Petry, said that his wife understood that prizes would not work for everyone. And she designed her studies to examine the “durability” of the effect; that is, how long people would maintain the desired behavior as the rewards diminished.
“She would have intensive rewards at the beginning, and then lighten up,” he said. “I think it’s true that a lot of people resort to bad behavior, but let’s say that 25 percent continue to stay clean. That’s probably much higher than it would have been if they didn’t have the opportunity in the first place,” he said.
Most encouraging, however, was the fact that even after the program was over, some people came up with their own strategies to ensure their continued good behavior. “They created their own fishbowls with their own pieces of paper. They self-perpetuated what they had learned in the clinical arena,” White said.
He added that rewards alone don’t accomplish the work. Often other behavioral modification strategies are required, as well as cognitive behavioral therapy. Incentives, he said, should enrich, not supplant, other forms of assistance, similar to Boggan’s work at Advance Peace, where money is only part of the equation.
“I think the relational aspect of our work is probably the most important thing (that we do). For some of these men, they have healthy, protective relationships for the first time in their lives,” Boggan said.