Earning prizes for fighting an addiction

  • A new way to urge drug abusers to get clean: give them tangible gifts when they test negative.
- Sahil Gupta

Mar 15, 2019-

Vancouver, B.C.—David Oliver wins gift cards for staying away from drugs. At St. Paul’s Hospital in Vancouver, British Columbia—which treats more overdoses than any other hospital in Canada—a program rewards users of cocaine and other stimulants with prizes when they don’t use. It’s a new approach to help substance abusers, and it’s also being tried in Veterans Affairs hospitals across the United States.

Mr. Oliver started the eight-week prize programs after being treated at St. Paul’s for an overdose and a bloodstream infection that had spread to his heart. The program staff test his urine for drugs once a week. If it shows no traces of cocaine or crystal meth, he gets to pull chips out of a hat. Each chip has monetary value: 5, 20 or 100 Canadian dollars. The clinics then use the chips to determine the value of the prizes they distribute—gift cards for coffee shops or grocery stores. “Everyone loves the prize. You get a chance to walk out of there with some money,” Mr. Oliver said.

Rewarding drug users directly is an approach also used at the Pender Community Health Center in the Downtown Eastside neighborhood, Vancouver’s ground zero for drug use and problems associated with it, like homelessness and mental illness. At this clinic, a program called Rewarding Change runs twice a year. It costs 800 Canadian dollars ($605) every year, for two eight-week cycles that enroll six or seven participants. Usually only four or five finish. In 2018, an overwhelming number of overdoses in Vancouver during a restructuring of clinic services kept the health center’s staff members so busy that they only ran one cycle.

The program could be cost-effective at 20 times the price. A Vancouver-based study in 2017 found that the average daily user of stimulants like crystal meth and cocaine was responsible for crimes that cost victims $6,700 a month.

Harkamal Sangha, one of the two counselors who manage the Pender clinic program, says the approach works well for people using stimulants. While most people are unable to get clean completely, he said, many get to a point where they can limit how many drugs they use and how often.

The idea for the program is rooted in behavioral economic theory and an understanding that people will change if they are given rewards to do so. Incentives have been used to discourage people from abusing cigarettes, cocaine, marijuana and heroin. Such programs have improved birth weights of babies by getting pregnant women to quit

smoking. They also have improved H.I.V. treatment by increasing how often patients take their antiretroviral medications.

In 2007, Britain’s National Institute for Health and Clinical Excellence approved incentive programs, and a programs and researchers have started using them in London. But even with the mounting evidence that this approach works, it’s mostly used in research settings and small clinics.

At the Pender clinic, Mr. Sangha said, counselors worried initially that patients be unwilling get their urine tested. But that turned out not to be the case, especially after patients understood that the test results were not meant to shame or punish them, but were a way to start discussions about the challenges of addiction, he said.

When the program began in 2013, the clinic gave out vouchers for every clean urine test. It later switched to a fishbowl model, in which participants draw from a prize bowl with small and large prizes, to help reduce costs and make the program more interactive.

Dr. Petry led work for community clinics to take up incentive programs and helped the Department of Veterans Affairs start using them.

Veterans Affairs, which runs the largest health care network in the United States, uses prize incentives in 116 of its hospitals. According to Dominick DePhilippis, a clinical psychologist, the V.A. started using incentives in 2011 after it received guidelines from a joint working group of addiction experts in the V.A. and the Department of Defense.

Seventy clinics started the program in 2011. Now more than half the V.A.’s 170 health centers offer prizes for clean urine tests. More than 3,000 patients have gone through the program and of the nearly 40,000 urine samples collected, more than 90 percent have tested negative, said Dr. DePhilippis.

The V.A. programs run for 12 weeks at a time. Twice a week, participants have their urine tested and get the opportunity to draw a chip from a fishbowl. Other treatments like counseling or medications for addiction continue. The patient gets extra draws for having negative urine samples in consecutive weeks.

Average earnings for veterans during the program are $150 to $200. Dr. DePhilippis said that the prizes come from the V.A. canteen; many veterans buy food, while others save up for more substantial items like Marine Corps leather jackets.

Each program designs its own prizes. Some clinics give increasing amounts of cash rewards or more draws the longer participants stay clean. Other programs have rewarded participants with paying jobs. Dr. Petry said programs that provide more valuable rewards and run long enough for changes in a patient’s behavior to get established generally get better results.

— © 2019 The New York Times

Published: 15-03-2019 11:49

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