San Francisco pilot program pays people with drug addiction in gift cards if they get clean

SAN FRANCISCO – San Francisco’s drug crisis can seem so overwhelming it’s difficult to know where to start. The city has now launched a pilot program aimed at rewiring the brains of those struggling with addiction to help them get clean. The program pays them to quit. 

Dana is one of those who’ve struggled with addiction. She says her addiction cost her job and her apartment. 

Homeless for three years, she says discovering she was pregnant in February helped her make her decision to enter recovery. 

“I didn’t really have a reason to change before, or least in my mind I didn’t think I had a reason to change,” said Dana. “But, he’s definitely given me a whole new perspective on things. A reason to change.”

Dana is one of 22 patients in the pilot program aimed at helping to treat the use of cocaine and methamphetamine. Doctors can treat opiate addiction with the use of medications; that’s not the case for stimulants. “For stimulants like cocaine and methamphetamine we don’t have a drug that helps with that, with the craving withdrawals,” said John Dunham, contingency management supervisor at Zuckerberg San Francisco General Hospital. 

“So, in order to do that, we’re looking at psychological approaches.”

The recovery incentive program aims to help stimulate those who use drugs by substituting a monetary reward for the drug. Doctors say they’re essentially rewiring the brain’s reward system. 

“The brain itself is very plastic,” said Dr. Jeffrey Hom from San Francisco’s Department of Public Health. “It’s very malleable and so what contingency management is doing is, again, the most effective treatment that we have against stimulant use disorder, is it’s trying to rewire some of those pathways that have been set up by month, years of substance use.”

Patients are offered up to $599 in gift cards over a 24-week program. Those in recovery start off earning $10 a week, with that amount increasing for each negative drug test. The research shows that despite the relatively small dollar amount, it’s the positive reinforcement that helps to alter the brain and keep patients in recovery. 

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Dana says she has been working hard on her sobriety and that so far the program is working for her. “The whole program in general, you know,” said Dana. “Just, the motivation and help with the gift cards and stuff. It’s definitely going to be a big help for us in the future.”

San Francisco has enrolled 22 people in the recovery incentive program. Patients who use drugs while in the program aren’t kicked out. Instead, organizers recognize that sometimes recovery can be a two steps forward, one step back process, and those who test positive are invited to return the following week for another drug test and the possibility of earning more gift cards.

Program administrators say the program is showing promise. “Approximately half of participants are testing negative at this time,” said Dunham. “Some of those participants have been using stimulants for greater than 20 years and have changed that behavior.”

This is a pilot program to help test its effectiveness. There are currently three test programs underway in the city.

California is the first state to receive federal approval to operate contingency management as a benefit in the Medicaid program.

Backers of the pay program say it has 50 years of medical evidence supporting it.