There’s an urgent need for treatment to help people addicted to cocaine and meth. One approach has decades of research showing it works but it’s hard to find.
AYESHA RASCOE, HOST:
For decades, even as deaths from overdoses continued to rise, people using cocaine, crack or meth have been told there’s no treatment to help them stop. But that’s not true. There is a recommended treatment. Member station WBUR’s Martha Bebinger went to a clinic that tackled stimulant addiction with a program called contingency management.
MARTHA BEBINGER, BYLINE: Four years ago, a young man named V was buying drugs on the street to relieve depression and anxiety. He couldn’t hold down a job. We’re only using V’s first initial to avoid job discrimination. One day, V dragged himself to the Brockton Neighborhood Health Center and broke down in a doctor’s office.
V: I didn’t even know what I was using, what addiction was, what was happening in my body, and I was scared ’cause I couldn’t stop.
BEBINGER: The doctor sent V to the Health Center’s addiction treatment clinic, where he learned about contingency management. V would be expected to set weekly goals, like showing up for appointments and not using drugs. If he met the week’s goal, he’d earn a prize, maybe a 10 or $20 gift card.
V: In the beginning, I was still on and off. But eventually, it was getting bad, and I needed help, so you know, I started to come more often.
BEBINGER: V has been off cocaine for a year now. He’s achieved goals beyond abstinence, like getting a job, going back to school and taking better care of himself. V has a garden and is learning to cook using prizes he earned in the program – a rice cooker, a blender and a hot plate.
V: It got me to think of ways I could do better, ways I could not use ’cause when I’m at home, my mind is, oh, how could I get the next prize? What’s my next goal?
BEBINGER: V’s story helps explain why the American Society of Addiction Medicine says contingency management should be standard treatment for patients addicted to stimulants like cocaine. Society President Dr. Brian Hurley, says contingency management more than doubles a patient’s chances of staying off drugs by redirecting a patient’s search for gratification from drugs to recovery.
BRIAN HURLEY: They have learned to rewire the brain, to kind of encode recovery and abstinence into their lives.
BEBINGER: Critics argue patients might exchange their blenders or gift cards for drugs. Some providers worry the prizes given to patients could be considered kickbacks and lead to charges that they are paying patients to be in the program. It’s widely accepted that capping the total value of rewards at $75 a year is legal. But Dr. Wilson Compton at the National Institute for Drug Abuse says $75 a year is not enough.
WILSON COMPTON: To be successful, the average amount needs to be in the hundreds of dollars, typically, for contingency management to work over, you know, weeks to months of trying to help somebody shape their behavior.
BEBINGER: Compton says he’s excited about a proposed federal change that would allow higher rewards. But Vs experience suggests contingency management is worth trying even with limited rewards, as overdose deaths involving cocaine and meth rise. At the clinic, V spins one of those clear plastic cylinders that spit out bingo numbers or winning raffle tickets. Today, it drops a slip of blue paper with a prize written on it.
V: There we go. And this one is just a good job.
BEBINGER: Like a pat on the back.
I ask V if he’s disappointed.
V: No, no, not at all.
BEBINGER: Because V is confident that he’ll achieve another goal, spin the wheel again – and who knows what his next reward might be? Access to contingency management is growing. It’s in VA health clinics across the country, and four states have Medicaid waivers to expand its use. But that means many people struggling with an addiction to stimulants are still not getting help that could turn their lives around. For NPR News, I’m Martha Bebinger in Brockton, Mass.
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