Can free money help people stay off drugs? These programs are trying it.

Boston Globe

2 days ago

Nothing stuck until Pagan, a 36-year-old personal caregiver from Revere, learned late last year of
engaged in physical exercise, Pagan was rewarded with $5 loaded onto a debit card.
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While modest, the payments were enough to motivate Pagan to keep coming back, week after week, to a program that taught her new strategies for controlling her cravings.
'When you're living on the edge, sometimes you need something — even if it's small — to feel better about yourself and your future," she said.
Pagan is among hundreds of people addicted to stimulants in New England who are part of a bold but debated experiment: giving financial rewards to people who abstain from illicit drugs.
In cities across the region, treatment providers are embracing the concept of monetary awards as they seek new ways to combat a troubling surge in the use of psychostimulants such as methamphetamine and cocaine.
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The approach is known as
Policy makers are banking on the intervention to help address a gaping hole in the substance use treatment system. There are no targeted medications for the estimated
'People have been brainwashed into thinking that depriving people and letting them `hit bottom' is the only way for somebody to get better, and contingency management flies in the face of that,' said Deirdre Calvert, director of the state Department of Public Health's Bureau of Substance Addiction Services. 'Most importantly, it works.'
While offering people small rewards for abstinence dates to the 1980s, the approach has been slow to catch on.
One of the biggest obstacles has been the moral objection to the idea of paying people to stay off drugs — which, critics argue, they should be doing anyway. Legal concerns have been another barrier. Treatment providers have long worried they could run afoul of
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Yet attitudes began to change a few years ago amid a troubling new reality. Many people were taking cocaine and meth without realizing it was
At the same time, states received the
So in 2021, Boston Medical Center received a $1.43 million grant from the Massachusetts Department of Public Health to launch
Interest in the program has far exceeded expectations.
Justin Alves, co-medical director for the START program and a nurse educator with the
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All told, 660 patients with stimulant use disorders have participated in the program since 2021; and more than 50 percent have been people of color, according to Boston Medical Center.
Organizers of the program are now looking to tap opioid settlement funds to expand the incentives to $300 to $500 per person per year, consistent with scientific studies showing that larger amounts are more effective in promoting abstinence.
'The $75 was enough to get people to come to group [meetings],' Alves said. 'By the time the $75 ran out, we had nurse-patient relationships with people and that's what has made the program blossom.'
Behavioral scientists said the programs are effective in part because the prizes act much like stimulants do — by increasing dopamine levels in the brain.
The US Department of Veterans Affairs was
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The concept is also taking hold in Maine, which has been
And in Vermont,
Some treatment providers are wary of giving prizes that they say patients could then sell or trade for drugs. Yet that hasn't emerged as a problem, say clinicians and researchers. The Howard Center tracks how participants spend the rewards and found they largely use the money to buy food, gas, and other basic items.
Rosario Malcolm-Testaverde credits a contingency management program with potentially saving his life.
He spent 15 years addicted to crystal methamphetamine, bouncing in and out of hospital emergency departments, before he discovered the Boston Medical Center program. He didn't need the money, yet the weekly prizes gave him an incentive to show up at group meetings. There, he encountered a community of people who understood the powerful pull of crystal meth and its dangerous side effects — including paranoia and auditory hallucinations.
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'I felt fully recognized as a human being,' said Malcolm-Testaverde, 36. 'And the rewards system helped replace the dopamine hit I would get [from crystal meth].'
At noon on a recent Monday, the mood was upbeat as Pagan and a dozen other people in recovery filed into a brightly lit conference room at the Boston Health Care for the Homeless office at 780 Albany St.
One by one, members introduced themselves and talked about what they were looking forward to in their lives. An older man named John described the daily challenge of staying sober when, each day, he encountered people using cocaine outside his apartment building in Cambridge's Central Square.
Among the last to speak, Pagan proudly announced to the group that she had just received word of a new job opportunity and was brushing up her resume — something she never would have imagined just a couple of years ago, when she was still living on the streets and using drugs.
'Hopefully a door opens because I feel like I'm ready,' Pagan said.
In an instant, everyone around the table burst into applause.
Chris Serres can be reached at