How rewards help recovery from addiction

How rewards help recovery from addiction

How rewards help recovery from addiction

Addiction Brain Rewards (Copyright 2022 The Associated Press. All rights reserved.)

Addiction Brain Rewards (Copyright 2022 The Associated Press. All rights reserved.)

Harold Lewis has been battling drug addiction for years, but only recently began to think that recovery could be fun.

The 59-year-old former cook earned small rewards – candy, chewing gum, gift cards, sunglasses, and headphones – for attending meetings and staying on treatment for opioid addiction during a 12-week program in Bridgeport. in Connecticut.

“Recovery should be fun because you are taking your life back,” Lewis said.

For a growing number of Americans, addiction treatment involves not only hard work, but also earning rewards, sometimes totaling $ 500, for negative drug tests or showing up for counseling or group meetings.

There is brain science behind the method, known as emergency management. And barriers to wider adoption of reward programs, such as government concerns about fraud, are starting to crumble.

“We are in a state of desperation where we have to do everything we can and this is something that works,” said Dr. James Berry, who heads addiction medicine at West Virginia University.

Overdose deaths in the United States soared to a record high during the pandemic. While opioids are primarily to blame, deaths involving stimulants such as methamphetamines are also increasing. People often die with multiple drugs in their system.

Medicines can help people stop abusing opioids, but stimulant addiction does not have effective medicine. Reward programs, especially when the dollar value increases with consistent performance, are widely recognized as the most effective treatment for people addicted to stimulants.

Since 2011, the U.S. Department of Veterans Affairs has used the method with 5,700 veterans. Rewards are coupons that vets redeem at their local canteen. Over the years, 92 percent of urine tests performed on these veterans have tested negative for drugs, said Dominick DePhilippis of the VA Substance Use Disorders Program.

When done right, rewards programs can be a bridge from the difficult days of early recovery to a better life, said Carla Rash, an associate professor of medicine at UConn Health, who studies the method. She helps people make better decisions right now by tipping the ladder when it’s hard to resist the immediate rewards of drug use.

Rewards can “provide some recognition for people’s efforts,” Rash said.

For Casey Thompson, 41, of Colville, Washington, the first month after quitting methamphetamine was the worst. Without stimulants, he felt exhausted and exhausted.

“Even on your feet, you might fall asleep,” Thompson said.

Earning gift certificates for passing drug tests helped, he said. During her 12-week program, she received about $ 500 in Walmart gift cards which she spent on food, shirts, socks, and shampoo. She is a qualified welder and is looking for work after a recent layoff.

“I’m a completely different person than I was,” Thompson said. “I was already planning to be clean, so he was just an extra.”

More than 150 studies over 30 years have shown that rewards work better than just counseling for addictions including cocaine, alcohol, tobacco and, when used in conjunction with medications, opioids.

The method is based on brain science. Psychologists have known for years that people who prefer small, immediate rewards over larger, delayed ones are vulnerable to addiction. They can swear to quit every morning and start using it again by the afternoon.

And neuroscientists have learned from imaging studies how addiction takes over the brain’s reward center, hijacking dopamine pathways and depriving people of the ability to enjoy simple pleasures.

“It’s using the same dopamine reward system that underlies addictions to promote healthy behavior change,” said University of Vermont psychologist Stephen Higgins, who pioneered the method in 1991. research shows that it helps pregnant women quit smoking and improves the health of their babies.

“Biologically, substance use lights up the same part of the brain that lights up when a person wins the lottery, falls in love, or experiences something truly positive and exciting,” said Northwestern University psychologist Sara Becker.

The same path lights up if someone wins a reward.

“This is part of what’s powerful about these programs,” Becker said.

Support has never been stronger. The Biden administration supports the method in its national drug control strategy. This fall, California will launch a pilot program designed to reward $ 10 gift cards that pass drug tests for stimulants. Oregon will use the state’s legal marijuana industry tax revenues to pay for similar incentives. Montana launched a program in March using a federal grant.

The U.S. Department of Health and Human Services is working to revise its guidelines on how much government grant money can be spent on prizes, rewards, and ATMs. Researchers say the current limit of $ 75 per patient is arbitrary and ineffective and should be raised to $ 599.

The method “is a widely studied and proven intervention that has been successful in treating people with a variety of substance use disorders,” said Dr. Yngvild K. Olsen, who directs the state government’s Center for Substance Abuse Treatment. United.

Reward programs can be low-tech – slips of paper pulled out of a fish bowl – or high-tech – using “smart” debit cards that are programmed so they can’t be spent at liquor stores or redeemed for cash at a ATM.

Maureen Walsh is a 54-year-old Philadelphia flower shop owner who avoids opioids with the help of a smartphone app called DynamiCare. When she passes a saliva test, she earns money on a smart card. She uses the money to gift herself a new pair of shoes or make a donation to a favorite cause.

“The reward for me was knowing that I was clean and the test proved it,” Walsh said.

For Lewis, the Connecticut man recovering from opioids, a weekly prize draw became a way to take home gifts for his mother.

“The awards make me feel good,” he said. “But the awards make my mom feel great. I’m talking about Tony the Tiger GREAT!”

On a recent summer day, Lewis had earned a chance to claim 10 tickets, 10 chances to win prizes, including a tablet. The grand prize escaped him, but he won six small prizes and $ 20 in shopping gift certificates.

“Recovery isn’t just clenched fists and clenched teeth, you know what I mean?” Lewis later said. “It can be fun, where you can exhale and you can breathe and get excited, because you don’t know what you’re going to win today.”


AP video reporter Emma H. ​​Tobin contributed to this report.


The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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