"Put Your Money Where Your Butt Is"

A friend of mine is trying to quit smoking. This will be his fourth time. After failed attempts with the patch, gum, and hypnosis, he is getting desperate for something that ‘works.’ He says that despite knowing how unhealthy smoking is for him, the fear of cancer, early death, premature aging, etc, just isn’t enough to scare him into quitting. As stupid as it sounds, he tells me, “I don’t have cancer right now, so holding off quitting one more day won’t matter.” It would seem that the disconnect between fulfilling his immediate desire (not quitting) and the possible outcome of this decision (dying of cancer) is too wide to impact his behavior.

His “plight” immediately came to mind when I came across this paper: Put your Money where your Butt is: A Commitment Contract for Smoking Cessation. Authors Xavier Gine (World Bank), Dean Karlan (Innovations for Poverty Action), and Jonathan Zinman (Innovations for Poverty Action) research the effectiveness of CARES (Committed Action to Reduce and End Smoking), a commitment product designed for people who want to quit smoking. In this study, research participants were offered the opportunity to open an interest-free savings account. The account required clients to make weekly deposits (of their own money) in the amount they would have otherwise spent on cigarettes. After six and again at 12 months, CARES clients underwent a urinalysis to test for recent nicotine consumption. CARES clients who passed the test received the balance of their deposits; those who failed (or did not take) the test forfeited the entire balance to charity.

The results were surprisingly positive, especially considering the bank account offered zero interest and there was a high likelihood of losing money. At six months, smokers randomly offered CARES were 3 to 6 percentage points more likely to pass than the control group, and CARES clients were 32 to 35 percentage points more likely to pass than the control group. The 12-month test revealed that smokers offered CARES were 4 to 6 percentage points more likely to pass the test than the control group, and CARES clients were 34 to 53 percentage points more likely to pass the test than the control group. The study also found that CARES treatment compares favorably to those found for nicotine replacement therapy in randomized controlled trials in other settings. The take-up rate was promising, as well: more than 1 in 10 of the people offered the treatment product signed up for the CARES program.

I’m not sure how this type of arrangement would work for my friend, but it does offer a provocative way to think about the potential of smoking cessation treatments.