NewsFinding a Fix


Paying drug users to get sober? 'It works'

Called contingency management, positive incentives
A program paying drug users to get sober is working on many levels
Posted at 5:07 PM, Oct 07, 2021
and last updated 2021-10-07 19:13:55-04

CLEVELAND — In an effort to make a dent in drug abuse problems, how do you feel about paying someone not to use illegal drugs? It could sound a bit strange to you, but it’s actually happening in our area. As we search for overdose solutions in our “Finding a Fix” series, we examine incentive programs that many are calling a significant part of saving lives.

“Growing up in the era, there was a lot of weed smoking and drinking and stuff like that,” said Derek Byrd, 68 from Cleveland. He was drafted during the Vietnam War. At age 20, it was the first time he’d been out of Ohio, and while in Texas for training, he was stationed near illegal drug operations.

“There was a lot of heroin available and it was was real cheap. So, I started out using heroin,” Byrd told us.

After coming home to Cleveland, he said he ran the streets, got in trouble, and served time behind bars.

“It doesn’t only affect you, but it affects your family. And they struggle tremendously behind that,” said Byrd.


The decades of drug use and pain piled up, and he told us he finally found himself standing inside the Cleveland VA Hospital, “in the hallway and crying,” said Byrd. As he recounted his past, he began to get emotional.

“Give me a minute,” he said as he started to cry during our interview. He wiped the tears from his eyes. He continued — he was in the hallway of the Cleveland VA, and he said he started “...telling them that I couldn’t do this anymore.”

“We’ve been trying to come up with newer, innovative ways to treat these conditions for quite some time,” said Dr. Kevin Young, a clinical psychologist at the Cleveland VA. Part of the innovation he’s talking about is something called "contingency management." It’s a positive reinforcement for each client’s negative drug test for several months.

“It helps," Young said. "It helps people stay motivated at times when otherwise it might be really hard."


The program doesn’t just give them cash, but rather gives them a chance to win gift cards, or perhaps an encouraging message. All they have to do is stick their hand in a fishbowl, pull out a card and see what they’ve earned. “250 of (the yellow, folded-over squares of paper) have encouraging messages on them like “Good job!” or “Way to go!” 209 of them have $1 prizes. 40 of them have $20 prizes and there is a $100 prize in there,” Young said.

Clients can use the vouchers at the VA’s store, which is stocked with all kinds of things, or they can use them to pick up a meal in the cafeteria. These kinds of incentives have been used in Cleveland and in VA hospitals all over the country helping thousands of veterans.

“Honestly, we’re just looking for stuff that works,” said Young.


It has worked. A recent major study done by Oxford University, the World Health Organization, Stanford University and other groups showed that paying people to stay sober had the highest significant results, had fewer client dropouts and should be used in future trials.

“For me, it gave me something to work toward,” said Byrd. That is on par with the psychology behind giving away things of little monetary value.

“The most common thing that people say helped them from our program is just the accountability that it provides,” said Young.


Dave Rich is the Director of Strategic Initiatives at the private recovery clinic called Brightview in Akron. The company, with many locations across Ohio, uses giveaways like mugs, toiletries, and positive words.

“Many, many of our patients, as a symptom of their disease — they burn their bridges,” Rich said. “They don’t have somebody in their life telling them they’re doing a good job, because, by the time they get to us, they don’t have a support system.”

Rich told us the old ways of making clients just feel bad about their drug use aren’t working.

“The science of addiction is telling us to go in a more progressive direction,” said Rich. “We’re heading into what, 50, 60 years of the war on drugs? And it’s as bad as it’s ever been.”


“We wish people would just stop using meth or whatever they’re using, but that’s not happening,” said California State Senator Scott Weiner. He's so impressed he’s hoping to use federal Medicaid dollars to offer a positive reinforcement program throughout California. If passed, it would be the first state in the U.S. to do so.

“I know someone who was addicted to meth, and contingency management works particularly well for meth and other stimulants,” Weiner said.

He told us the program is more efficient than citizens paying for drug-related ambulance rides, arrests, and incarcerations. “It is a tiny percentage of what it would cost taxpayers otherwise,” said Weiner said.

Contingency management is a program that Byrd told us kept him sober and what really helped is that counselors were thinking outside the box for drug treatment.

“We need people out here that actually care. We do.” said Byrd.

“And solutions that really work?” we asked.

“Right,” he answered.

The Cleveland VA Hospital is looking to expand its incentive program to help current drug users who need surgeries to get sober so they can have those procedures done.