Candy, cash, gifts: how rewards help recover from addiction

Harold Lewis has struggled with addiction for years, but it wasn’t until recently that he started to think recovery could be fun.

The 59-year-old former cook has won small prizes – candy, gum, gift cards, sunglasses and headphones – for attending meetings and undergoing treatment for opioid addiction during of a 12-week program in Bridgeport, Connecticut.

“Recovery should be fun because you’re reclaiming your life,” Lewis said.

For a growing number of Americans, drug treatment involves not only hard work, but also rewards – sometimes totaling $500 – for negative drug tests or for showing up for counseling or meetings. band.

There is a brain science behind the method, known as contingency management. And barriers to wider adoption of rewards programs, such as government concerns about fraud, are beginning to crumble.

“We’re in a state of desperation where we have to go all out and this is something that’s working,” said Dr. James Berry, who leads addiction medicine at West Virginia University.

Overdose deaths in the United States have reached an all-time high during the pandemic. While opioids are primarily to blame, deaths involving stimulants such as methamphetamines are also increasing. Often people die with multiple drugs in their system.

Medications can help people stop opioid abuse, but stimulant addiction has no effective cure. Rewards programs – especially when the dollar value increases with consistent performance – are widely recognized as the most effective treatment for people addicted to stimulants.

Since 2011, the US Department of Veterans Affairs has used the method with 5,700 veterans. Rewards are vouchers that vets redeem at their local canteen. Over the years, 92% of urine tests performed on these veterans have come back negative for drugs, said Dominick DePhilippis of the VA’s Substance Use Disorders Program.

When done right, reward programs can be a bridge between the tough days of early recovery and a better life, said Carla Rash, an associate professor of medicine at UConn Health who studies the method. It helps people make better decisions in the moment, tipping the scales when the immediate benefits of drug use are hard to resist.

Awards can “offer a bit of recognition for people’s efforts,” Rash said.

For Casey Thompson, 41, of Colville, Washington, the first month after quitting meth was the worst. Without stimulants, he felt burnt out and exhausted.

“Even standing up, you might fall asleep,” Thompson said.

Earning gift cards to take drug tests helped, he said. During his 12-week program, he received around $500 in Walmart gift cards which he spent on food, shirts, socks and shampoo. He is a welder by training and is looking for work after a recent layoff.

“I’m a totally different person than I was,” Thompson said. “I had already planned to be clean, so that was just an extra.”

More than 150 studies over 30 years have shown that rewards work better than counseling alone for addictions including cocaine, alcohol, tobacco and, when used with medication, opioids.

The method is based on brain science. Psychologists have known for years that people who prefer small, immediate rewards to larger, delayed rewards are vulnerable to addiction. They can swear to quit every morning and start using again in the afternoon.

And neuroscientists have learned through imaging studies how addiction takes over the brain’s reward center, hijacking dopamine pathways and robbing people of the ability to enjoy simple pleasures.

“It’s largely by using this same dopamine reward system that underlies addictions to promote healthy behavior change,” said University of Vermont psychologist Stephen Higgins, who pioneered the method. in 1991. Her recent research shows that she helps pregnant women quit smoking and improves the health of their newborns.

“Biologically, substance use lights up the same part of the brain that lights up when someone wins the lottery, falls in love, or experiences something really positive and exciting,” said University psychologist Sara Becker. Northwestern.

The same path is lit if someone wins a reward.

“That’s part of what’s powerful about these programs,” Becker said.

The support has never been stronger. The Biden administration supports the method in its national drug control strategy. This fall, California will launch a pilot program designed to reward $10 gift cards by passing drug tests for stimulants. Oregon will use tax revenue from the state’s legal marijuana industry to pay for similar incentives. Montana launched a program in March with a federal grant.

The US Department of Health and Human Services is working to revise its guidelines on the amount of government grants that can be spent on prizes, rewards, and payment cards. The researchers say the current limit of $75 per patient is arbitrary and ineffective and should be raised to $599.

The method “is a widely studied and proven intervention that has been successful in treating people with a variety of substance use disorders,” said Dr. Yngvild K. Olsen, who directs the US government’s Center for Substance Abuse Treatment. .

Reward programs can be low-tech – scraps of paper from a fishbowl – or high-tech – using “smart” debit cards programmed so they can’t be spent at grocery stores. alcohol or converted into cash at an ATM.

Maureen Walsh is a 54-year-old flower shop owner from Philadelphia who avoids opioids with the help of a smartphone app called DynamiCare. When she passes a saliva test, she earns money on a smart card. She uses the money to buy a new pair of shoes or donate to a cause close to her heart.

“The reward for me was knowing I was clean and the test showed that,” Walsh said.

For Lewis, the Connecticut man recovering from opioids, a weekly raffle has become a way for him to bring home presents for his mother.

“The awards make me feel good,” he said. “But the awards make my mum feel good. I’m talking about Tony the Tiger SUPER!

On a recent summer day, Lewis had won the chance to draw 10 slips – 10 chances to win prizes, including a tablet. The jackpot eluded him, but he won six small prizes and $20 in grocery gift cards.

“Recovery just isn’t all clenched fists and clenched teeth, you know what I mean?” Lewis said later. “It can be fun, where you can exhale and you can breathe and get excited – because you don’t know what you’re going to win today.”


AP video journalist Emma H. ​​Tobin contributed to this report.


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