NEW YORK ADDICTS CAN CASH IN ON STAYING CLEAN

Treatment Program Patients Earn Vouchers For Passing Drug Tests

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
compact disc 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 be worth only $2.50.

If past research is a guide, teens getting the vouchers will stay
clean at rates about 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 was "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 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.