These days, we’re doing anything to combat the worsening drug epidemic.
At St. Paul’s Hospital in Vancouver, British Columbia (which treats more overdoses than any other hospital in Canada), a former patient has created a program to reward users of cocaine and other stimulants with prizes when they don’t use.
“I was sober for 19 years from cocaine and 14 from alcohol,” creator and former substance user, John David Oliver said in an interview with the New York Times. In 2013, Oliver began using cocaine again after feeling overwhelmed by the stress of two jobs, a marriage, and raising two kids.
Prizes To Stay Clean
The former patient started the program after being treated at St. Paul’s from an overdose and an infection in his bloodstream that spread to his heart. The staff at the hospital continue to test his urine for drugs once a week. If his urine showed no sign of substances, he pulled a chip out of a hat. Each chip has monetary value: 5, 20, or 100 Canadian dollars which was then exchanged for prizes such as gift cards to grocery stores or restaurants.
“Everyone loves the prize. You get a chance to walk out of there with some money,” Oliver said. He stated that knowing he had a chance of being rewarded immediately helped him stay clean. “It’s the instant gratification — receiving something with a minimum amount of work,” he said. “It appeals to that stimulant user’s quick brain, the do-get, do-get.” Since, he has received about $150 in vouchers himself; he used them to treat himself to a shaving razor, an electric toothbrush, and a Big Mac at McDonald’s.
The program at St. Paul’s made him accountable by forcing him to disclose his drug use, while the chance to draw a chip was a big incentive. “It really was quite pathetically as simple as that,” he said.
The Incentive Movement
As this approach may not be the most conventional, it’s also being tried in a multitude of other treatment programs including the Veterans Affairs hospitals across the US.
While medication-assisted treatment programs to treat opioid and alcohol addiction have become increasingly available, there’s no type of medication for those using stimulants. Another program in Vancouver called the Pender Community Health Center has been using the concept which runs twice per year which has helped those struggling with stimulants as well as other substances such as opiates and alcohol. The program costs 800 Canadian dollars each year for two eight week cycles that enroll six participants. According to a Canadian study published in 2017, costs for crimes associated with users of crystal meth and cocaine accounted to $6,700 per month. This means, that if these programs were to be successful, it could be cost-effective at 20 times the price.
As a trailblazer in the incentive movement, Nancy Petry – a professor at the University of Connecticut School of Medicine, dedicated her career to studying how to change behavior using incentives before passing in July of 2018. In 2005, the professor even led a study that showed stimulant users stayed in treatment longer when incentives were used. Additionally, in a a 2008 study pointed that offering incentives for people to change outperformed traditional methods of counseling. Dr. Petry initially led work for these clinics to take up incentive programs, or “contingency management,” and implemented the approach into the Department of Veterans Affairs.
Today, the VA uses prize incentive programs in 116 of its hospitals since it started in 2011. The V.A. incentive programs run for 12 weeks at a time and twice a week participants have their urine tested to get the opportunity to draw a chip from a fishbowl for prizes. While the incentives continue, so do other treatments such as therapy and medications for addiction. In this program, the patient gets extra draws for having negative urine samples in consecutive weeks.
Gaining More Attention
So, why haven’t these type of approaches garnered more attention within the United States? While some people have difficulty with the idea of paying drug users, Dr. Petry stated in an interview that insurers will not directly benefit from the program, as they don’t have a system to pay drug users.
Dr. Petry admits that each program doesn’t necessarily succeed, however noted that the longer programs run and provide valuable rewards to establish changes in a person’s behavior, generally, better results are seen. Another issue is that some clinics delay in testing urine, however testing the person immediately upon arrival can keep them in the program longer.
While insurers may not be seeing direct results from the approach, we may see more of these programs pop-up within the United States as an effort to combat the crippling drug epidemic. As evidence proves these programs help those who struggle by giving material prizes for continued sobriety – but also gives an incentive for those to stay clean long enough to come to understand what the true gift at stake is – a better life.