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.
Most importantly, when clients test positive, there are no negative consequences. They simply don’t get their reward and drop back to the initial $10 the next time they deliver a negative test. “If they test positive, we take it as an opportunity to engage with them,” Duff explains. “We say, ‘We’re glad you’re here. Let’s sit down and talk about what happened.’ The goal is to keep them completely engaged. The longer they stay talking to a counselor, the better off their chances in the long run.”