Prize-based Contingency Management for people struggling with stimulants

VCH Vancouver’s Pender Community Health Centre (CHC) was faced with the predicament of clients receiving methadone/suboxone for opiate dependency who continued to use illicit stimulants such as cocaine, crack, and crystal meth. People on opiate replacement therapy have the best chance of success when the treatment is used as a temporary fix while they work on the root cause of addiction through counselling or other psychosocial measures. Pender CHC’s clients tend to be marginalized, live in the DTES, and face physical, social and emotional barriers to care.

“Above the addictions, the environment, and the underlying trauma in their lives, our clients are people first. Exceptional, talented, caring, wonderful people: each one has a story to share,” says Teri Dean, Adult Alcohol and Drug Counsellor, who’s worked at Pender CHC for 12 years.

Rewarding Change is a Vancouver Community psychosocial support group for people in the DTES who struggle with illicit stimulant use, run in 12-week cycles out of Pender CHC. A closed group run by two facilitators, Teri and Harkamal, and supported by Dr Andrea Shewchuk, the weekly meetings provide much more than support in a safe environment.

“As the participants build trust, there is more talking and sharing with each other. Talk is without judgement: this group is not about punishment or shame,” says Harkamal Sangha, a Clinical Counsellor at Pender CHC for six years. “Over time, we see people coming out of social isolation, and even developing friendships. They become more open and often start to ask about other programs available at the CHC.”

The support group uses a Contingency Management treatment model that involves positive reinforcement through the use of incentives. Rewarding Change members who have a stimulant-free urine drug screen get the chance for a prize from the program “Fishbowl.” The Fishbowl is a lottery-type system: prizes include gift cards of differing amounts ($5, $10, $25), as well as non-monetary items, such as positive affirmations. Behaviour change is always recognized through Fishbowl prizes, and the unpredictable schedule of reinforcement has been shown to produce more consistent response rates than set rewards (Petry, Martin, Cooney, & Kranzler, 2000).

The 12-week Rewarding Change program is getting results: participants are often connected to other CHC programs, they build relationships with CHC staff including primary care, and some return for another 12-week session. Opportunities to plug into relationships and services keep participants connected to the centre and the supports it provides.

Rewarding Change is a viable model for behavioural change, says Maureen Sexsmith, Manager, Pender CHC: “I see hope, and I see resiliency in the people who come through our doors each week. Without this, they wouldn’t come in, or they wouldn’t come back.”