Earning, Spending, and Drug Use in a Therapeutic Workplace

By Subramaniam, Shrinidhi; DeFulio, Anthony et al. | The Psychological Record, June 2017 | Go to article overview

Earning, Spending, and Drug Use in a Therapeutic Workplace


Subramaniam, Shrinidhi, DeFulio, Anthony, Jarvis, Brantley P., Holtyn, August F., Silverman, Kenneth, The Psychological Record


Drug addiction is a chronic health condition characterized by persistent drug use in the face of undesirable physical, social, or economic consequences. This impaired decision making is reflected in other maladaptive choices like financial mismanagement (Hamilton & Potenza, 2012). In one study, individuals with substance dependence were twice as likely to carry financial debt than individuals who did not have substance dependence, despite similar incomes between groups (Jenkins et al., 2008). Descriptive studies on drug use in substance-dependent populations (Satel, Reuter, Hartley, Rosenheck, & Mintz, 1997; Swartz, Hsieh, & Baumohl, 2003) reported that drug use was elevated when paychecks or disability payments were scheduled and that financial gains predicted noncompliance with standard drug-abuse treatment (see Rosen, 2012, for a review).

Financial mismanagement and drug use involve choices between rewards varying in quality, delay, and magnitude. An individual might choose to spend a small amount of money immediately rather than saving for a larger amount in the future. Likewise, an individual might choose to use drugs immediately rather than abstain to avoid health problems in the future. Delay discounting is the extent to which individuals forgo those large, delayed rewards for immediate, small rewards (Rachlin & Green, 1972). Studies described a continuum of elevated discounting (i.e., a tendency to choose the smaller, immediate reward) to low discounting (i.e., a tendency to choose the larger, later reward); found similar discounting across real, potentially real, and hypothetical rewards; and validated the discounting task across several populations (see Bickel & Marsch, 2001, for a review).

Delay discounting differs as a function of drug use and financial mismanagement (Carroll, Anker, Mach, Newman, & Perry, 2010; Hamilton & Potenza, 2012). Drug abusing populations have been shown to discount monetary outcomes more than populations who do not abuse those drugs (Bickel, Odum, & Madden, 1999; Kirby, Petry, & Bickel, 1999; MacKillop et al., 2011; Madden, Petry, Badger, & Bickel, 1997) and risky drug-seeking behavior, such as a willingness to share needles, is associated with elevated delay discounting (Odum, Madden, Badger, & Bickel, 2000). Delay discounting is associated with financial mismanagement, although the relation is relatively underexplored in comparison to drug use. In studies assessing delay discounting with large samples of non-drug-dependent adults, those with elevated discounting of monetary rewards were more likely to have credit card debt and less likely to pay credit card bills in full than those with lower discounting rates (Chabris, Laibson, Morris, Schuldt, & Taubinsky, 2008; Meier & Sprenger, 2010).

A better understanding of the relation between drug use and financial choices may inform the design of substance abuse treatment. Tucker and colleagues (Tucker, Foushee, & Black, 2008; Tucker, Roth, Vignolo, & Westfall, 2009; Tucker, Vuchinich, Black, & Rippens, 2006; Tucker, Vuchinich, & Rippens, 2002) found that financial choices are a consistent predictor of treatment success. Specifically, allocating a greater amount of money to savings relative to alcohol expenditures predicted alcohol moderation at 1--and 2-year follow ups after participants made a resolution to moderate their drinking (Tucker et al., 2002). In an intervention targeting financial behavior (Rosen, Carroll, Stafanoivics, & Rosenheck, 2009), veterans with recent alcohol or cocaine use were randomly assigned to a money management intervention or a control group. Those participants receiving the intervention were invited to attend sessions with a money manager who stored funds, trained appropriate financial choices, and helped develop treatment goals to improve money management and encourage abstinence. Participants in the control group were given a workbook, were asked to construct a budget and track expenses, and were invited to attend sessions with a counselor to support the use of the workbook. …

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