The Brookings Institution is a Washington, D.C.-based nonprofit organization with a history of producing in-depth research on current public policy topics. A case in point is a new article on strategies for increasing participation in addiction treatment programs.

The article is written by Dr. Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University. In the piece, Dr. Humphreys describes two main routes for improving participation rates for addiction treatment programs: the carrots — incentives to participate — and the sticks — requirements to participate.

The Carrots

Dr. Humphreys imagines what marketing experts would make of the efforts to draw people into addiction treatment programs. Would they recommend improving the user experience, starting with the emergency room visit that is most often at the beginning of addiction treatment customer acquisition?

Would they cut response times, improve patient communications, and handle referrals to other services such as housing, healthcare, and employment? Would they improve school training in addiction treatment? Would they increase the number of people employed in the addiction treatment industry?

Dr. Humphreys cites some of the current barriers that are keeping customers out of addiction treatment:

• Many programs don’t offer FDA-approved medication-assisted therapy
• Many insurance plans fail to offer substance use disorder (SUD) benefits
• Hospitals and clinics lack staff training in addiction treatment

“These quality problems likely lower individuals’ willingness to enter and stay in treatment,” writes Dr. Humphreys. Simply making care more accessible would bring in more patients. But that’s not so simple after all:

Implementing such a policy will be challenging, because the lead funder of addiction treatment in much of the country is Medicaid, which is slated for the largest cuts in the program’s history.

The Sticks

Dr. Humphrey wisely points out some differences between SUDs and other chronic diseases. “[U]nlike depression, chronic pain, and the like, which no sufferer is sad to give up, addicted individuals are often ambivalent about behavior change.”

Due to having mixed feelings about the need for treatment, more than 90% of those seeking addiction treatment are being pressured to do so. Of those 90%, three-quarters are being pushed into addiction treatment as a result of legal problems.

The result is a network of drug courts, DWI courts, and other diversion programs that reduce penalties for those who successfully complete addiction treatment. The incentives here are sticks of harsher sentencing for those who refuse treatment or drop out.

The ultimate stick is civil commitment: imprisoning addicts and forcing them to undergo treatment. This can be ordered for persons who pose a serious risk to themselves or to others, even if they have not broken any laws.

Dr. Humphreys acknowledges that states such as Washington and Oregon are backing off on drug law liberalization, while the Canadian province of British Columbia is broadening its ability to use civil commitment to compel addiction treatment.

Dr. Humphreys notes, however, that civil commitment is a slow (and expensive) process that stands little chance of making a significant impact on homelessness or addiction. Instead, he suggests a third route, both carrot and stick.

A Combination of Carrots and Sticks

Offering free housing for people while undergoing addiction treatment is considered to be a pretty significant carrot. It can be seen as a stick to the extent that discontinuing treatment means the loss of housing. Dr. Humphreys says this approach has led to the Housing First movement:

The Housing First philosophy holds that it [makes] more sense to provide stable, safe housing first and worry about treatment and behavior change later.

We have covered the attempts of many states to provide affordable housing for those undergoing addiction treatment. Dr. Humphreys makes clear that unless those beds are restricted to those in recovery, addiction problems stagnate. In 2023, three people per week were dying of overdoses in California’s Housing First homes.

The other combination approach, which is surprisingly not mentioned in the Brookings Institution report, is the most effective addiction treatment program of all: contingency management.

Contingency management is paying people to stay in addiction treatment and to test negative for banned substances. It is astonishing, but even the smallest amounts of compensation have been effective at keeping people in treatment long enough to recover.

In the long run, carrots are much less expensive than sticks. As long as assistance is tied to improvement, the results are positive and encouraging. Solutions such as “do nothing” turn out to be incredibly expensive. Even the most brutal solution of all — involuntary lethal injection — turns out to be more expensive than paying people small amounts to get measurably better.

Written by Steve O’Keefe. First published November 10, 2025.

Sources:

“Strategies for increasing participation in addiction treatment,” Brookings, October 30, 2025.

“B.C. to expand involuntary care for those with addiction issues,” CBC News, September 15, 2024.

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