This story was originally published by Reasons to be Cheerful
When John Duff first heard about the California plan to pay amphetamine addicts for staying sober, his initial reaction was disbelief. “I couldn’t wrap my head around it because especially for people like me who’ve been around for a long time, it sort of goes against everything I’ve ever heard,” says Duff, who has been working as an addiction counselor at the substance abuse counseling center Common Goals in Grass Valley, California, since 2005. But since he started piloting the program at Common Goals in January 2024 with 45 of its 140 clients, he has grown into a supporter: “It really works, and frankly, it’s the cheapest of all our programs. The taxpayer gets the most bang for their buck.”
Unlike for alcohol or heroin, there are no targeted medications to help drug users wean off stimulants like cocaine and methamphetamine. While the deadly opioid crisis might make more headlines, 65 percent of drug-related deaths in California now involve stimulants, especially meth. Deaths from these kinds of stimulants more than quadrupled between 2011 and 2019, and the number of amphetamine-related E.R. visits increased nearly 50 percent between 2018 and 2020, according to an analysis by the Oakland nonprofit California Health Care Foundation. Therefore the state is urgently looking for new ways to rein in the drug crisis, and in early 2023, it began the controversial experiment: paying people to stay sober. This could be one part of the puzzle in securing an unexpected outcome: For the first time in decades, overdose deaths have plummeted by 10 percent between April 2023 and April 2024.
Two dozen counties, including San Francisco, Los Angeles and Orange, are participating in the “recovery incentive” or “contingency management,” as it’s called. The state has allocated $60 million for the pilot phase. The 24-week program essentially uses positive reinforcement with the aim of readjusting people’s brains so they associate being sober with gratification. After each negative drug test, they receive a reward. For the first negative test, they get a gift card in the amount of $10, for the second $11.50, up to $26 or a total of $599 (because any amount larger than that needs to be reported to the IRS). It is part of a bigger initiative, CalAIM, to connect the most vulnerable and high-need citizens with resources and non-traditional benefits in a whole-person approach.
“We are encouraged to give them their incentive immediately because the reward stimulates the reward center in the brain in the same way gambling or methamphetamines do,” Duff explains. “Though they could take the gift card and immediately get a burger at Burger King, many of them want to wait and ‘bank’ the reward until they can get something bigger, maybe Nikes at Walmart for their kids or a gas card.”
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Common Goals is the only outpatient addiction counseling center in rural Nevada County, which has about 100,000 inhabitants. For someone to enroll in its contingency management program, they need to be a member of Medi-Cal, the state’s Medicaid program for low-income residents, and they need to have a confirmed diagnosis of addiction to stimulants such as methamphetamine or cocaine. After an initial medical exam, they come in twice a week, and later once a week, for the urine test.
Though the incentives are not life-changing, “they really do keep people coming back,” Duff has observed, “especially the homeless population.”
“It’s that little something that’s holding me accountable,” Common Goals client Quinn Coburn, a former construction worker who is trying to overcome his meth habit, told the Los Angeles Times.
