A simple rewards program could be the key to helping people with methamphetamine addiction. California is seeing a rise in meth use and drug overdose deaths. So it’s launching a pilot program where patients would receive a gift card to stores like Walmart each time their drug test comes back clean.
This type of treatment is known as “contingency management.”
“Contingency management is just the idea of rewarding positive behavior with a financial incentive. It can be cash, it's often gift cards. And it can be used to reward all kinds of behavior, from staying off stimulants to staying off opioids to stopping smoking, to showing up to your doctor's appointments,” says Marisa Kendall, homelessness reporter with CalMatters.
She explains that meth users would sign up for this program, get drug tested once or twice per week for six months, and every negative test would earn them a gift card that starts at $10. The value of the gift card would increase with every negative test, so in total, they could receive $599.
The Department of Veterans Affairs has used this program for over a decade, treating more than 6,000 vets nationwide, she adds.
Why meth in particular, as opposed to fentanyl, which is also a major problem? She says meth is rising, and it’s a big problem among the state’s unhoused population. “And it's one of the hardest addictions to treat because there's no medication that you can take for it. For an opioid addiction, doctors can prescribe methadone or something like that. But there's nothing like that for a stimulant addiction.”
When the program is done, however, there’s a chance that people could relapse. That’s what happened with one person Kendall spoke with — J.W. in San Francisco.
“He had been using meth for about 20 years, ended up in the ER with heart failure. And he really liked this program, he got gift cards to Safeway every time he either showed up to a doctor's appointment, took his heart medication, or got a negative drug test. And he would use the cards — at a time when he wasn't working — to buy sandwiches and little treats at Safeway. … But when the program ended … he said he's still using [meth] up to three times a day,” she recalls. “And he wasn't exactly sure why it didn't work for him. He regretted that he didn't get clean because he'd recognized this was a good opportunity to do so. But he said at this point, using has just become such a routine in his life that he just couldn't shake the habit.”
And so, some people may view the gift card system as a bandaid, and what’s needed is more intensive drug rehabilitation, including helping someone secure housing and get a job.