California is embracing contingency management, a non-traditional but effective treatment for meth and cocaine addiction, which rewards individuals with gift cards for staying drug-free. This approach, dating back to the 1980s, involves regular drug tests over several months, where participants receive a gift card for each negative result, with the value increasing with continued success. Unlike opioid addiction, which has FDA-approved medications, stimulant addiction lacks such treatments, making contingency management a valuable alternative. Studies suggest that this method, which leverages positive reinforcement, can double the likelihood of individuals quitting meth or cocaine compared to traditional counselling.

Despite its effectiveness, contingency management faces challenges such as stigma and concerns over potential fraud. Critics argue that it resembles bribery rather than a legitimate treatment. However, recent shifts in attitude, particularly amid rising overdose deaths linked to fentanyl-laced substances, have led California to pioneer the use of contingency management funded by Medicaid. With nearly 4,000 participants and over 75% of tests showing negative results, the program is showing promising outcomes. Efforts are underway to expand access, despite administrative hurdles that limit its reach to more patients. For more details, visit NPR.