From Transfers to Treatment: Bridging Social Policy and Substance Use Treatment

With substance use disorders continuing to contribute significantly to morbidity and mortality worldwide, innovative financial strategies have emerged as powerful levers to bridge the gap between social determinants of health and clinical outcomes. Conditional cash transfer (CCT) programs represent one such strategy, offering monetary assistance to low-income households, with the condition that the funds are used towards social services, such as healthcare, education, and nutrition. These programs not only alleviate immediate financial hardships but also create pathways for improved long-term health outcomes, as research has shown their effectiveness in reducing child mortality and improving nutrition.

Recently, a study was published that evaluated the novel impact that these programs can play in addressing substance use, making it one of the few studies to evaluate this association. Dr. Lidiane Toledo and her team conducted a population-based study in Brazil investigating the implementation of the Brazilian CCT, Bolsa Familia (BFP), in relation to hospitalizations for substance use disorder (SUD). Using a Poisson regression model with linked hospital and BFP program records between 2008 and 2015, they found that enrollment in BFP was associated with a 16.89% decrease in SUD-related hospitalizations, which was particularly pronounced in municipalities with lower socioeconomic status as classified by the Brazilian Deprivation Index.

Supporting these findings, evidence from Mexico further reinforces the broader relevance of CCT programs in addressing SUD. Mexico’s CCT program, Oportunidades, was one of the earliest CCT programs in the world and was designed to provide residents with similar benefits as Bolsa Familia. A 2007 evaluation of the program found that a 200 peso-increase in a wife’s salary significantly reduced the likelihood of her husband partaking in heavy alcohol consumption by 15%. Like BFP, Oportunidades was originally designed to increase access to social services, such as health and nutrition or school attendance. However, by creating household-level incentives, these programs impacted behaviors beyond the direct recipients. The policy implications are clear: CCTs may offer a scalable, upstream intervention to reduce substance-related harm, especially in low- and middle-income countries (LMICs) where formal treatment services remain scarce.

Nonetheless, while CCTs show great promise, financial incentives alone are not a panacea. To maximize impact, these programs should be coupled with further efforts to enhance the healthcare infrastructure for substance use treatment globally. For instance, in areas where access to behavioral health or addiction specialists is limited, training non-physician specialists could significantly enhance service availability. This can include social workers and community health workers, especially since they are often more deeply involved with their communities and are better equipped to provide culturally relevant care and support.

Additionally, integrating SUD care into existing CCT-linked primary care visits — such as those required under BFP and Oportunidades — would increase uptake and continuity. Specifically, these integration efforts could aid in reducing stigma surrounding substance use, as it would normalize SUD care under the broader healthcare infrastructure. Telehealth services may also offer a complementary strategy for expanding care in geographically remote settings. By utilizing telehealth platforms, clinicians could provide remote appointments, monitoring, and follow-up visits, which helps to overcome some of the logistical barriers imposed by physical distances and limited infrastructure.

CCTs are not substitutes for treatment infrastructure, but when strategically integrated, they can serve as effective, equity-oriented platforms for SUD prevention and care. This evolving model challenges us to rethink our approach to SUD prevention and treatment. Instead of treating these conditions as isolated clinical problems, we must consider the broader social and structural context — recognizing that poverty, social deprivation, and economic instability are not merely relevant factors, but necessary considerations in developing effective, equitable interventions. Given the widespread prevalence of SUD globally, such public health interventions are crucial to reducing health disparities and fostering holistic recovery.

Photo: StockFinland, Getty Images

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