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Paid to Stop – How is Contingency Treatment Helping Users Kick Meth in California?

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Kick Meth in California?

At the end of 2021, California became the first state in which federal approval was granted for Medicaid to cover contingency management for addictions to drugs such as Methamphetamines and more. This sets a precedent, possibly opening the doors for other states also to support this approach to recovery from drug abuse.

The fact that the bill passed California legislation with enthusiastic support from both Republicans and Democrats alike surprised many, including those who had actively spoken in favor of it, such as Senator Scott Wiener (D-San Francisco). Although the efficacy of contingency management (CM) is undisputed, it remains a relatively new, bold, and therefore contentious approach. If this treatment method is accepted, this means that rehabilitation for meth can use contingency management as a way to support ongoing recovery and assist in continuous efforts to battle drug addiction in the long run.

What are Contingency Management Programs?

The principle on which contingency management programs are based is reward for negative drug tests. This reward sometimes extends to initially simply reducing drug use. Participants provide regular urine samples, and if these come back negative for drugs, they receive a modest sum of money. The money is not paid to them at once – they first have to demonstrate sustained abstinence over a given period of time. This incites participants in contingency management programs to persevere in their efforts, and allows them to gradually build up significant periods of clean time. Contingency treatment is currently changing the landscape of addiction treatment, in the US and beyond.

How Does Contingency Management Work?

The basic goal of contingency management is to change the drug use habits of people suffering from substance use disorders (SUD). But beyond helping them stop using, or cut down on their drug use, it helps change other behaviors too. It aims to address any behavioral patterns which lead them back to drugs, and help them modify the way they respond to life’s challenges. It is a proven tool for helping create a new template for how to live on a day-to-day basis. As such, it is defined as a behavioral therapy.

Read Also: 9 Tips to Keep in Mind When Driving in California

Contingency management works by reinforcing abstinence from drugs by providing a reward. Generally, this reward is monetary, though at times coupons or vouchers that can be exchanged for purchases are also used. The repetition of demonstrating sobriety (by providing urine samples) and being rewarded for it strengthens a person’s resolve, and ‘reinforces’ their new behavior of not taking drugs. It also supports the acquisition of other behaviors relating to life in general. Since those participating in contingency management do not receive their money immediately, they in effect ‘work their way’ towards an even larger reward once the money is handed over. This provides extra incentive and motivation.

Contingency Treatment in California

In California, contingency treatment (CT) is currently primarily implemented for cocaine and meth addiction. These are the two substances for which CT appears most effective when treating abuse. This is particularly the case when it is combined with other behavioral therapy (such as CBT). California’s efforts to expand contingency treatment in the state are a response to the ever-worsening drug epidemic. More traditional approaches to treating SUDs have not prevented overdoses from meth or other stimulants from tripling in recent years. In 2020, these actually surpassed fentanyl overdoses in number. It has become urgent to put in place effective measures.

A Newer Treatment to Replace Failing Ones

While the opioid epidemic is also wreaking havoc on certain segments of society and costing the nation billions of dollars annually, at least medical treatments exist. There are three FDA-approved medications – methadone, buprenorphine, and naltrexone – that can be prescribed to treat opioid addiction. There is no such medication for meth or cocaine.

The push in California to embrace CT more fully is also a reaction to a general despondency among stimulant users, due to this lack of treatment options. The hope is that by making contingency management more accessible to greater numbers, more people will come forward to seek treatment. Stimulant users will see that it has worked for friends or acquaintances, and will want the same freedom.

Efficacy

The basic principles of CT – mainly positive reinforcement – are actually used in areas other than recovery too. Weight loss and fitness training programs both respond positively to CT. Using reward in place of punishment has been shown to work well in education also. Studies have shown that CT is definitely effective. In 2011, the Department of Veterans Affairs began an initiative to make contingency management more readily available to patients. Seven years later, it noted that the average percentage of patients undergoing CM who provided negative samples was 91.1%.

Criticism of Contingency Treatment

In spite of multiple studies confirming that contingency management gives demonstrable positive results, opinion remains divided over the treatment. Some doubt the ethics of such a practice, believing that paying people to give up their drug use amounts to giving out bribes. A less subjective objection concerns the benefits of the treatment in the long term. Some doctors question whether abstinence can last once active treatment (prize benefits) has been stopped. With the incentive of a reward removed, they argue, there is less motivation to remain abstinent in the longer term. However, it appears that a taste of a life away from drugs, when sufficiently long, does in fact help long term sobriety. To the extent that a 2018 study showed that even 12 months after ceasing to receive benefits, patients were still more abstinent than those who had undergone other treatment modalities. It would seem some critics of the approach are beginning to soften – in the face of a drug epidemic that refuses to bend to more traditional treatments, the need for something new that works is self-evident.

Towards a Brighter Future?

California sees CT as a potential way to stem the tide of the drug crisis. This perspective is evidence-based, and there are a number of differences between CT programs and other treatments. First of all, CT is not a passive, but an active treatment – patients must earn their rewards by their actions. As a result, it is also empowering, since it gives patients the opportunity to demonstrate – to themselves, to other program participants, and to their doctors – that they can remain abstinent. This, in turn nurtures their self-worth and confidence. Currently, West Virginia and Washington are considering following in California’s footsteps and adopting a similar policy around CT. If they do so successfully, other states will no doubt follow.

 

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