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Harold Lewis has been battling drug addiction for years, but he recently started thinking that recovery could be fun.
The 59-year-old former chef won small prizes — candy, gum, gift cards, sunglasses and headphones — for attending meetings and staying in opioid addiction treatment during a 12-week program in Bridgeport , Connecticut.
“Recovery should be fun because you get your life back,” Lewis said.
For a growing number of Americans, addiction treatment involves not only hard work but also earning rewards, sometimes as much as $500, for testing negative for drugs or showing up for counseling or meetings of group
There is brain science behind the method, which is 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 pull out all the stops and this is something that works,” said Dr. James Berry, who directs addiction medicine at West Virginia University.
Overdose deaths in the United States hit an all-time high during the pandemic. While opioids are the main culprits, deaths involving stimulants like methamphetamines are also on the rise. People often die with multiple drugs in their system.
Medications can help people stop abusing opioids, but stimulant addiction has no effective medication. Rewards programs, especially when the value of the dollar 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 percent of urine tests given to these veterans have come back negative for drugs, said Dominick DePhilippis of the VA’s substance use disorder program.
When done right, reward programs can be a bridge from the tough days of early recovery to 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 rewards of drug use are hard to resist.
(AP Video/Emma H. Tobin)
Rewards can “provide some 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 drained and exhausted.
“Even standing up, you can fall asleep,” Thompson said.
Earning gift cards for passing drug tests helped, he said. During her 12-week program, she received about $500 in Walmart gift cards that she spent on food, T-shirts, socks and shampoo. He is a trained welder and is looking for work after a recent layoff.
“I’m a totally different person than I was,” Thompson said. “I was already planning to be clean, so it was more.”
More than 150 studies over 30 years have shown that rewards work better than counseling alone for addictions such as cocaine, alcohol, tobacco and, when used in conjunction 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 may promise to quit every morning and start using again in the afternoon.
And neuroscientists have learned from imaging studies how addiction takes over the brain’s reward center, hijacking dopamine pathways and robbing people of their ability to enjoy simple pleasures.
“It uses a lot of the same dopamine reward system that is the basis of addictions to promote healthy behavior change,” said University of Vermont psychologist Stephen Higgins, who pioneered the method in 1991. Their recent research shows that it helps pregnant women quit and quit smoking. improves the health of your babies.
“Biologically, substance use lights up the same part of the brain that lights up when a person wins the lottery, falls in love, or experiences something really positive and exciting,” said psychologist Sara Becker of the Northwestern University.
The same path is lit if someone wins a reward.
“That’s part of what’s so powerful about these programs,” Becker said.
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 that pass 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 U.S. Department of Health and Human Services is working to revise its guidelines on how much government grant money can be spent on prizes, rewards and cash cards. Researchers say the current cap of $75 per patient is arbitrary and ineffective and should be increased 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 Center for Treatment of substance abuse by the US government.
Rewards programs can be low-tech, pieces of paper out of a fishbowl, or high-tech, with “smart” debit cards programmed so they can’t be spent at liquor stores or converted to cash at an ATM.
Maureen Walsh is a 54-year-old Philadelphia flower shop owner who avoids opioids with the help of a smartphone app called DynamiCare. When you pass a saliva test, you earn cash with a smart card. She uses the money to treat herself to a new pair of shoes or donate to a favorite cause.
“The payoff for me was knowing I was clean and the test proved it,” Walsh said.
For Lewis, the Connecticut man in opioid recovery, a weekly prize draw became a way to bring home gifts for his mother.
“The awards make me feel good,” he said. “But the awards make my mother feel very good. I’m talking about Tony the BIG Tiger!”
On a recent summer day, Lewis had earned a chance to draw 10 slips — 10 chances to win prizes, including a tablet. The grand prize eluded him, but he won six small prizes and $20 in grocery gift cards.
“Recovery isn’t all fists and clenched teeth, you know what I mean?” Lewis said later. “It can be fun, where you can exhale and you can breathe in and get excited, because you don’t know what you’re going to win today.”
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AP video reporter Emma H. Tobin contributed to this report.
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The Associated Press Department of Health and Science is supported by the Department of Science Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.
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