As reported by the Associated Press, January 21, 2006.

NYC Clinic Offers Addicts Incentive: Stay Clean, Earn Prizes

NEW YORK -- Even at age 18, Jessica knew she had plenty of reasons to quit OxyContin. The addictive painkiller consumed her life, made her sick and devoured every dollar she had.

So when a treatment program offered her an additional incentive - a small payment for every drug-free urine sample - it initially struck her as a bit silly, especially when her first clean test earned her $2.50. But soon she had enough money to pay some bills and buy a new CD player.

"At first, its sort of like, 'Yeah, yeah. Whatever," said Jessica, who agreed to be interviewed on the condition that only her first name be used. "But once we got going, it was kind of nice to be rewarded for doing something good."

The idea of paying people to stay sober has caught on around the country as a growing amount of research has indicated it may help keep notoriously fickle addicts in treatment.

San Francisco health officials are one year into a program offering methamphetamine addicts vouchers worth up to $40 per week for staying off drugs.

Smokers in a two-year study at the University of Florida can get vouchers redeemable at Target, Wal-Mart or Amazon.com if they pass a test on whether they've had a cigarette.

And a study of 415 cocaine or methamphetamine users published last October in the Archives of General Psychiatry found they stayed in treatment longer if they had a chance to win a prize.

"It can be a very powerful technique," said Dr. Lisa A. Marsch, an investigator with the National Development and Research Institutes who helped treat Jessica in Burlington, Vt., and is now recruiting patients for a similar clinic at St. Luke's-Roosevelt Hospital Center in New York.

Teens getting help at St. Luke's Adolescent Addiction Treatment Center receive medication and counseling and submit three urine samples a week to prove they are clean.

Results are available on the spot. Pass, and the patient gets a voucher worth a preset amount of cash.

The values start small, but rise with every clean result. The second test might be worth $3.75, the third, $5. If a person remains drug free for two months, they could earn as much as $596.

There are some limits on how the vouchers can be used; you can't buy cigarettes or alcohol. Almost anything else is fair game, from sneakers to CDs to a new iPod.

The catch, if there is one, is that the vouchers reset to their lowest value if the patient tests positive. Someone who failed their 50th test wouldn't lose the money they had earned so far, but their next clean sample would only be worth $2.50.

If past research is a guide, teens getting the vouchers will stay clean at rates roughly 20 to 30 percent higher than if they had counseling and medication alone, Marsch said.

"If it increases their motivation to stay clean even a little, it's worth doing," she said.

The psychological boost was a subtle one for patients like Jessica, who went through the program three years ago and has been in and out of drug treatment since age 15.

"Growing up, I didn't have the best family life," she said. The payments, while small, offered a rare bit of encouragement. "I wasn't used to that extra pat on the back."

She said she "tremendously proud" of the CD player she bought with the money. "I would brag to my friends that I'd gotten it for staying clean."

The voucher system has been successful enough that it has prompted exploration of lower-cost variations, including one system that gives addicts a chance to win prizes.

Nancy Petry, a researcher at the University of Connecticut School of Medicine, conducted several studies in which a clean urine sample earned addicts a dip into a bowl filled with tickets representing various awards.

Sometimes the slip entitled them a small item like a bus token or a pair of socks. Once a week, they might win new dishes or movie tickets.

And somewhere in the bowl was a jumbo prize worth about $100. Each time a person tested clean, their odds of hitting the major prizes improved.

"It turned out to be a big incentive," Petry said of her experiments, which have involved about 1,000 people.

Typically, only 20 to 30 percent of patients might complete a full 12-week treatment course without failing a test, but with the prize system in place, that rate improved to between 40 and 60 percent, Petry said.

It is less clear what such programs mean for a patient's long-term success.

The theory is that people who complete a treatment course of any type are more likely to get clean than those who don't. Almost all patients, however, eventually have at least one relapse.

Jessica, now 21, is among those who have struggled. She stayed sober for seven months after completing Dr. Marsch's program, but slipped hard once it ended. Within a few years, she had moved on to heroin.

Her latest treatment program, in which she takes methadone and attends Narcotics Anonymous meetings twice daily, has her feeling optimistic. She has been clean for one month.

"I feel like I'm on the right track," she said.