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Quitting Meth Pays Off

Material rewards appear to be quite effective at inducing addicts to stop. But whether they'll stay clean when the gifts end is a matter of debate.

November 14, 2005|Charles Ornstein | Times Staff Writer

SAN FRANCISCO — For more than two decades, Robert Bowers stole money, jewelry, identities, even silverware, to feed his methamphetamine addiction. He landed in prison, rehab and skid row hotels.

Until earlier this year, when the government paid Bowers to quit.

A little-heralded program run by San Francisco's Public Health Department over the last year has given meth users rewards worth up to $40 per week to stay off drugs. And, in a break from traditional approaches, participants receive no counseling or lectures, even if they test positive for meth use.

Their end of the bargain is simple: Show up at a clinic three times a week, urinate in a cup and collect their reward -- a voucher, not cash -- if they test drug-free.

"Here I am getting clean, I feel better and I'm getting something for it," said Bowers, 42, who says he hasn't used meth since early February and has put more than 45 pounds on his formerly ravaged 128-pound frame. "That means something."

Though just a pilot program, the San Francisco venture is the latest in a string of experiments and studies over the years to point in the same intriguing, if controversial, direction: Addicts respond remarkably well to material rewards, even little ones.

"You're using the exact same technique that parents use with their children every day," said Nancy Petry, a researcher at the University of Connecticut School of Medicine who is studying this approach. "It's behavior modification and behavior shaping."

The findings could be especially significant in California, where methamphetamine use continues to surge. It has surpassed alcohol and heroin as the drug of choice among those seeking treatment. The drug increases arousal and reduces inhibitions, sometimes leading to violence, child neglect and serious health problems such as malnutrition and heart failure among chronic users.

In essence, the voucher approach replaces one reward with another -- the high of drugs such as meth with the mental boost of grocery money, a gift certificate or a rent subsidy. Given the power of addiction, as shown by many addicts' desperate and self-destructive acts, the trade-off might seem woefully insufficient. But for some reason, researchers say, it works.

Since November 2004, 159 participants have enrolled in the 12-week San Francisco program, which is geared toward gay and bisexual men. So far, about 38% of those eligible have completed their stint. Though the success of drug programs is hard to gauge and not systematically tracked, experts said the San Francisco program's numbers are comparable to or better than those of other publicly funded outpatient treatment options.

What makes the program most noteworthy is that it is simpler than conventional treatment -- less time-consuming and substantially less costly, proponents say. Because there are waiting lists for drug rehabilitation in many parts of the country, including San Francisco, such programs also broaden options for treatment.

The benefits go beyond stemming drug addiction, extending to prevention of sexually transmitted diseases, said Dr. Jeffrey Klausner, San Francisco's director of STD control. Extensive research shows that meth is associated with risky sexual behavior.

Some treatment experts are peering over San Francisco's shoulder. Others are borrowing the concept or adding touches of their own.

The Seattle and King County Department of Health, for instance, is preparing a study that rewards gay and bisexual men who remain drug-free. The Addiction Institute of New York recently started giving people vouchers to show up to treatment sessions, regardless of whether they are drug-free.

For nearly 15 years, research has indicated the usefulness of rewards in conjunction with traditional treatment, especially in motivating patients to stick with their programs.

Then, earlier this year, UCLA researchers published one of the first studies to challenge the idea that vouchers had to be paired with another treatment to work. Over 16 weeks, meth users who received vouchers tested negative for drug use 83% of the time, compared with 75% for those receiving cognitive behavioral therapy alone.

"Clearly, it wasn't the money," said Steven Shoptaw, one of the UCLA researchers. "It was the fact that somebody recognized them."

The reward programs, known as "contingency management," haven't caught on widely in practice, experts say -- at least, not yet.

"Because the treatment approach is a little different from giving medications or counseling, probably that has added an unfamiliar wrinkle to it," said Stephen Higgins, a University of Vermont researcher who pioneered the use of vouchers for drug addicts.

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