Washington state is giving people gift cards to help get them off drugs

When William Lester Jr. decided to get into a 12-week program to tackle his drug use, he says he weighed just 68 pounds. The Seattle, Wash., resident had been using heroin for 35 years and, recently, methamphetamine too.

He knew something had to change when he was admitted to hospital for kidney failure.

“I wasn’t ready to stop for years until one day I said, ‘I’m done, I can’t do this anymore,'” said Lester, who lives in supportive housing in Seattle.

He credits his case worker for putting him on the path of a contingency management program — which rewards abstinence from stimulant drugs, such as methamphetamine or cocaine, with gift cards.  

Gift cards twice a week

The program, which operates in states including California, Montana and Washington, asks participants to give a urine sample and do a quick test to see if they have been using drugs or not in the last few days.

For every negative test, the patient gets a reward. In Washington state, and at Plymouth Housing in Seattle where Lester lives, that reward comes in the form of gift cards. 

“It’s a little unusual because the way it works is that it’s a procedure, where the person comes in and they usually have a really positive, fun interaction with the clinician,” said Michael McDonnell, a professor in the Department of Community and Behavioral Health at the Elson S. Floyd College of Medicine at Washington State University. 

“If it shows that the person hasn’t used [stimulants] in the last few days, they have a really big celebration and give that person a gift card,” explained McDonnell. 

For every negative urine sample, which happens two times a week, the patient gets a $12 gift card. And the amount incrementally increases with every negative test. Participants can receive a maximum of $599 US per calendar year.

If a patient tests positive for drugs, they don’t get kicked out of the program. Instead, their gift card amount decreases and they have to build their way back up. 

The gift cards can be used to buy groceries, clothes or even electronics.

Contingency management has decades of evidence supporting its success to help people stop or reduce their stimulant drug use, according to McDonnell.

The program is administered out of clinics, except in Seattle where it operates out of Plymouth Housing, a permanent supportive housing non-profit organization for people struggling with long-term homelessness. There, 40 people have followed the program for more than a year. 

At Plymouth, the goal is to bring the program to people instead of having them go to an out-patient clinic. 

According to Aaliyah Bains, the behavioural health program manager at Plymouth Housing, this is big. 

“It was not an easy thing to just take out of the clinical setting and push into housing,” she remembers. But it works.

“We actually have higher participation rates and higher completion rates than in clinical settings,” Bains said, referencing preliminary data.

Another difference lies in the fact that at Plymouth it is a peer-support worker who comes to the resident’s unit, meaning they are seen by someone who has experienced addiction themselves.

“I’ve been to AA, to a lot of stuff like that, but see, I cannot relate to anybody that’s not been where I’ve been,” Lester said, adding it was a support worker in his housing unit who got him to join the program. 

Taking part in it wasn’t always easy. Lester says he thought he could cheat the system, but was surprised to stick with it.

“I stopped [using drugs] thanks to the program”. 

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Evidence-based approach

The bulk of the evidence for contingency management comes from decades of research on veterans.

The U.S. Veteran Affair Department implemented the program in 2011. But attitudes — such as viewing rewards as bribes — slowed down its use for the general public. 

Things shifted when the overdose epidemic became a public health crisis.

California was the first state to cover contingency management under Medicaid and “to evaluate the effectiveness of the treatment at scale,” according to the California Health Department.

In 2021, the states of Montana and Washington started using the program on a large scale for stimulant use disorder.

In Washington state, 24 clinics offer the 12-week program. Preliminary results show that of more than 200 participants, about 70 per cent have been engaged and seeing reductions in their stimulant use, according to McDonnell.

British Columbia also has a few contingency management programs, although very limited. 

“It is an important part of the continuum of care for substance use,” a spokesperson for the Ministry of Health said in a statement. 

B.C.’s programs are run by Vancouver Coastal Health and Fraser Health, and include a 12-week group counselling program delivered by AIDS Vancouver. Most of them focus on stimulant use.

The need for effective treatment programs has grown more urgent in recent years as the toxic drug crisis has worsened. 

Although fentanyl and other opioids have made headlines since 2016 in Canada and North America as a whole, stimulants are also present in a growing proportion of overdose deaths. In Canada, stimulants were found alongside opioids in 64 per cent of toxic drug deaths in 2024.

During the same year in B.C., cocaine was detected in 52 per cent of overdose toxicology reports and methamphetamine was found in 43 per cent. 

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Bains says contingency management gives people the chance to succeed at something. 

“So many programs are all or nothing, you have to be 100 per cent sober or you are not successful. That’s just not what contingency management is.”

Bains has also witnessed first hand the pride of some of the 40 participants of the one-year Plymouth pilot project.

“I’ve seen it change people. Giving them the opportunity to have $20 a week for somebody that has no income is life changing”.

Housed patients more likely to finish 

While one may think financial rewards wouldn’t work as well for more well-off patients, McDonnell says they have proven to be a strong incentive regardless of income. 

“I have doctors, lawyers and other people who are very well compensated financially, but are really desperate to stop using their substances … and they are motivated by the idea that they are rewarded,” explained the researcher. 

If anything, it is unhoused people who fare poorly in the contingency management program.

“They are less likely to finish the program because they have so many other things they are dealing with,” McDonnell said. And, he added, they may rely on stimulants to keep them awake for safety.

“It’s dangerous to be homeless: someone might come and steal your stuff, you might be assaulted,” McDonnell said.

According to Lester, being housed at Plymouth for six years made him more likely to say yes to the program. 

Despite being low income, he says the incentives were less important than the accountability process and having someone believe in his success. 

“I could tell you I feel better now than I’ve ever felt in my whole life,” he said proudly.