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Commentary: Charging into Recovery – Is Cash Really a Gateway Drug?

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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.

7 Responses to this article

  1. Avatar of Bruce Pedersen
    Bruce Pedersen / October 28, 2012 at 1:16 am

    I live in Oregon and have suffered from chronic pain for over 20 years . I have been on methadone forest of that time. Recently I had two dear friends that moved to Spring Hill Fla. They are both on methadone and are having a hard time filling their prescriptions. They tell me that once a pharmacy runs out they have to wait for a new month. Could you give me some advice that I can pass along to them to help them better understand this situation . They need help and don’t know people they can get info from. Thank you and God bless Bruce PEDERSEN

  2. GennaX / October 26, 2012 at 9:36 pm

    The idea of denying addicts access to cash to prevent drug use/relapse makes sense in the way incarceration does. Such schemes are costly. To reduce unit cost supporters will argue for mandatory expansion. Users and dealers will find ways around the ‘problem’ and the additional costs will be bourne by all of us.
    I understand why it could be helpful – not having £20 in my pocket might have made a difference on a number of occasions – but when risk aversion measures involve denial of freedoms and promote a nanny state over individual responsibility this is inherently dangerous. As such I agree with the TRI sentiments.

  3. Bill Crane / October 26, 2012 at 3:01 pm

    I am certain that availability of cash lubricates any track toward relapse. However, the “Next Step” debit card is silly – any street-wise addict can convert that commodity to available cash easily. However, my concern has always been how the availability of disposable income leads to initial alcohol and drug use (primarily the traditional drugs: commercially manufactured alcoholic beverages, marijuana, cocaine, heroin, etc.). The more funds available to youth – the more likely there will be drug use. Higher income youth tend to have more and better quality drugs available to them than the drugs used by low income youth. Consequently, the best prevention method is family poverty. However, this is not how drug use in America is perceived – quite the opposite. Rich kids use drugs in their well sheltered homes (from prying neighbors and law enforcement) – poor kids use the drugs they have available on the street in full view of everyone (rich kids are busted at home by their parents and sent to rehab – poor kids are busted on the street by the police and sent to jail). Perception is everything and has driven our approaches to drug laws and prevention strategies (or at least it has for many years in the past). Things are changing however, the (finally) general acceptance of environmental prevention approaches reveals more truth about drug use in America. The prescription drug abuse problem (and solutions) now underway is a clear example of the cost and availability model.

  4. Joe / October 26, 2012 at 1:36 pm

    Interesting. Good article. It should also be noted that the so called drug gateway theory is also “based upon isolated events, individual observations and broad generalizations rather than empirical data.”

  5. Sheryl Letzgus McGinnis / October 26, 2012 at 12:16 pm

    We lost our 31-year-old son to a really bad drug addiction. My husband and I always said that having cash and transportation were two of the worst things an addict could have.
    Sheryl Letzgus McGinnis
    http://www.sherylletzgusmcginnis.com

  6. Avatar of Doug Lyons
    Doug Lyons / October 26, 2012 at 11:54 am

    Interesting that the researchers cite cash as largely a non issue relating to relapse “while clients were in Tx. ”
    At the risk of sounding smug…duh.
    While the Jury on these kind of financial instruments is clearly out, this kind of statement is the stuff that gives supposed empirical evidence, not to mention researchers a black eye or at least elicits a hardy guffaw
    from experienced therapists

  7. GennaX / October 27, 2012 at 12:03 am

    I’m really sorry for your loss and appreciate your opinion, but strongly disagree. I would list two of the worst things an addict can have as:
    (1) a government that both supports prohibition AND limits access to substitute treatments (the addict by necessity must engage with criminals/criminality and is dependant on an unsafe/unsecure supply, and
    (2) lack of understanding from family, friends & community. Addicts’ behaviour, how they cope with their addiction is heavily influenced by social attitudes. Being excluded and stigmatised makes the experience of addiction worse than it needs be for the addict and wider society. Where feelings of rejection already exist, a tough love approach causes more pain and is a barrier to recovery. I speak from personal experience.

    The fact that some parents are prepared to help fund their son/daughter’s habit to keep them away from crime suggests they would not see having cash as a major problem either.

    NB Please be assured none of the above are directed at your relationship with your son.

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