Mark had been wanting to quit using meth for a while when someone pointed him to the folding table propped up at the skid row site where homeless people stop for showers and laundry.
If his urine tested negative for stimulants, the man advised him, “they give you a gift card.”
Behind the table, a program assistant hastened to clarify that it was a chance at a gift card — just a chance. But a chance was enough for Mark, who began filling out paperwork to sign up for the 12-week program, hoping the incentive could help him break from his addiction.
“I’ve lost everything. My family. My kids. My grandkids. My wife. My housing. Just everything,” said the 56-year-old, who declined to give his last name. He has been living in a van in South Los Angeles. “It’s really affecting me bad. But it’s hard not to do it.”
It is a simple idea at first glance: Giving people rewards, week by week, can encourage them to keep doing difficult things.
Researchers say such “contingency management” programs use the reward systems in the brain to nudge people away from drug use.
“This isn’t just paying people to do what they should do,” said Steve Shoptaw, a UCLA professor of family medicine who has researched treatments for stimulant use disorder. “This is an intervention that actually stimulates the brain to work in different ways so that their goals are met.”
But in drug treatment in Los Angeles County, contingency management remains uncommon, despite strong evidence that such programs can help people stop using meth and other stimulants that can derail and end lives.
Last year, more than 1,700 people in L.A. County died from overdoses that involved methamphetamine — including 430 deaths in which meth was the only drug identified by the county coroner, according to county figures.
Across the country, laws against paying patients for business under federally funded health programs have inhibited efforts to offer gift cards or other rewards as an incentive for staying off drugs. Federal officials have carved out exceptions, but such programs have also run up against philosophical objections to providing external rewards for abstinence.
In California, a bill that would have broadly authorized Medi-Cal to cover such incentive programs was vetoed last year by Gov. Gavin Newsom, who said it should first be tested under a pilot program. That pilot, initially scheduled to launch in July, has since been pushed back to this fall, and state officials say that the federal government has “explicitly recognized” that the incentives planned under the program do not violate the federal rules.
Proponents argue that the method has already proved itself, including at the Department of Veterans Affairs, where such programs have been used to help people quit stimulants for over a decade. The National Institute on Drug Abuse has called such interventions “highly effective.” Physicians see it as an especially important tool in helping people get off meth, for which no medications are yet approved by the Food and Drug Administration.
“This would be the gold standard if it was a medication,” said Dr. Siddarth Puri, an addiction psychiatrist at LAC+USC Medical Center who has taken its contingency management program outside the hospital walls, setting up a table once a week at the Skid Row Community ReFresh Spot, where homeless people go to shower, use restrooms, do laundry and get other services.
The LAC+USC program is not a part of the state pilot, but was funded through a $250,000 grant from the Center at Sierra Health Foundation. It has enrolled dozens of people who are supposed to check in twice weekly, once at the ReFresh Spot, and once by smartphone, sending in an image of their test results between Tuesday visits.
If their urine tests negative, participants get the opportunity to randomly choose a number, which is checked against a numbered list of rewards — either a Target gift card for $10 or $20 or a…
Read More: Can a Target gift card help sway you to stay off meth?