Offering people small rewards for not using drugs — known as contingency management — dates back to the 1980s. Patients are tested for drugs regularly over several months. They receive a gift card for every negative result, and payouts grow with each test. This treatment method is gaining ground in California.
Why it matters: The treatment is based on a well-established concept that positive reinforcement is an effective motivator. But the approach has failed to catch on in spite of the evidence.
Why now: In the last four years, some states have relied on federal grants or court rulings against opioid manufacturers to fund their contingency management programs. In California — where overdose deaths involving meth have skyrocketed — health officials asked the federal government to allow the state to become the first in the nation to pay for contingency management with Medicaid dollars.
Bernard Groves has spent five years trying to quit methamphetamine.
He lost his job. He lost his car. He nearly lost his apartment. Worse than that, he says, his addiction has hurt his family.
“I went [to lunch] with my auntie and I saw such sadness in her eyes,” Groves said.
The 35-year-old checked himself into several rehab programs in San Diego and San Francisco hoping "to be that Bernard I used to be for the people that I love."
But each time, Groves felt the progress he made in therapy morphed into people talking at him, telling him what to do. Eventually, he would always return to meth.
“My best friend was like, ‘I don't get it, Bernard. You put your mind to something, you've always been able to achieve it. Why can't you get over this meth?’ ” Groves said. “I don't know why. And it feels awful.”
Unlike opioid addiction, there are no FDA-approved medications for the more than 3 million Americans addicted to stimulants like meth and cocaine. Instead, the most effective treatment is low-tech — and more controversial: Give people retail gift cards usually worth less than $30 in exchange for negative drug tests. Research shows that it works, and after more than three decades of resistance, policymakers are finally giving that strategy a chance.
Bernard Groves (left) has been going to contingency management sessions with his counselor Andrew Dertien (right) since June to try to kick his meth addiction.
(
Lusen Mendel for Tradeoffs
)
‘This isn’t treatment’
Offering people small rewards for not using drugs — known as contingency management — dates back to the 1980s. Patients are tested for drugs regularly over several months. They receive a gift card for every negative result, and payouts grow with each test.
The treatment is based on a well-established concept that positive reinforcement is an effective motivator. Animals pull levers when rewarded with food. Students’ behavior improves by letting them watch TV after class. Compared to traditional counseling, researchers have found people are twice as likely to stop using meth or cocaine if they receive gift cards.
Studies suggest the immediate excitement of getting a gift card after a negative test replaces the dopamine rush people get from using drugs. Scientists hypothesize this activity effectively rewires our brains.
But the approach has failed to catch on in spite of the evidence.
Rick Rawson, a professor emeritus of psychology at UCLA and early proponent of contingency management, says many addiction care providers historically dismissed the treatment as a form of bribery.
“You would hear things like, this isn't treatment, this is just paying people not to use drugs,” Rawson said. “It wasn't a medicine. It wasn't talk therapy. It was this sort of transactional thing.”
Concerns of fraud have also stymied contingency management's growth. Rawson persuaded California health officials to fund a pilot program in 2005. But the work stopped abruptly after federal health officials warned participating clinics that the project ran afoul of rules designed to prevent doctors from luring patients into their offices and then charging Medicaid for care they never provided.
“I'd pretty much given up,” Rawson said after Medicaid shut down the pilot. “I figured this just isn't going to happen.”
Contingency management gets second chance
Outside of the Department of Veterans Affairs, which has offered contingency management since 2011, the treatment lay dormant for nearly a decade. But attitudes began to shift after the synthetic opioid fentanyl fueled a rise in overdose deaths in the U.S., Rawson said.
“People started to recognize that a lot of these people are buying cocaine or methamphetamine and dying of fentanyl overdoses because fentanyl is mixed into the drug supply,” said Rawson.
In the last four years, some states have relied on federal grants or court rulings against opioid manufacturers to fund their contingency management programs. In California — where overdose deaths involving meth have skyrocketed — health officials asked the federal government to allow the state to become the first in the nation to pay for contingency management with Medicaid dollars.
The Biden administration greenlit the plan along with a broader package of non-traditional health care services California is testing called CalAIM. Under the state’s contingency management program, which launched last year, gift cards after each stimulant-free urine test start at $10 and climb up to $26.50. A patient who tests negative every time over six months can earn up to $599, which can be paid out individually or in a lump sum.
It's unclear if that is enough money to persuade people to quit. Most studies show contingency management works best when patients can make upward of $1,000. California picked a lower amount to avoid triggering tax problems for patients or compromising their eligibility for other public benefits like food assistance.
The value of the gift cards have worked for Bernard Groves. He's been off meth since the first week of July, one of his longest stretches since he started trying to shake the habit.
He's used the gift cards to buy exercise weights at Walmart and food for his pet bird London at Petco. He's also used the money to pick up donuts or a movie night with his mom, sister and grandma.
“Being able to treat my family and do things for them is special,” Groves said. “It brought some joy back in my life.”
He’s surprised at how much pleasure he’s gotten from the program.
“Like, how could you say you're excited to pee in a cup? But I was, every week.”
Groves hopes this approach will help him finally kick his meth use. Recent studies have found people are more likely to stay off stimulants for up to a year after these programs, compared to counseling and 12-step programs.
California’s approach leaves some patients out
Nearly 4,000 people have participated in California’s new program as of September 2024. Researchers at UCLA say at least 75% of urine samples submitted by patients in the program have been negative for stimulants, and clinics say many of their patients have gotten into housing, gone back to work and reconnected with their families.
But California has an estimated 210,000 people on Medicaid who are addicted to meth or cocaine. Medicaid in California generally only covers addiction treatment through specialty addiction clinics, so most people who get their treatment from primary care doctors, community health clinics or hospitals are unable to access contingency management.
Ayesha Appa is an addiction specialist who runs an HIV clinic at San Francisco General Hospital, where most of her patients are homeless, using meth and on Medicaid. She offered contingency management through a private grant until funding ran out in June, and she’s ineligible to offer it through CalAIM.
“It feels both incredibly frustrating and just heartbreaking as a provider,” Appa said, to know a powerful treatment exists that she can’t offer. “It feels like I have a patient living with diabetes, and instead of being able to offer them insulin, all I can do is talk with them about diet and exercise, even though I know there’s a better option out there.”
She thinks often of one patient, a 45-year-old woman, who “desperately wanted to stop using” meth, but who struggled to quit. Appa urged her to visit a CalAIM clinic to get contingency management treatment, but the woman didn’t trust other doctors. Ultimately, the woman overdosed and died.
“What if we could have offered her contingency management in the clinic that she was coming into already?” Appa said. “When I think about her, it's an equal mix of guilt and regret because it truly felt like we could have done more.”
'People get better'
California Medicaid Director Tyler Sadwith believes in the power of this treatment, but has taken a careful approach as the state attempts to scale this work because of the stigma contingency management still has among some health providers and lawmakers.
Sadwith said he appreciates that more people could benefit right now, but starting small gives proponents their best chance of convincing state and federal leaders to extend and expand the program beyond its current end date of 2026.
“We need to prove that this works and that this works well,” Sadwith said. “We feel the importance and the weight of getting this right” as the first state in the nation to cover this sort of treatment under Medicaid.
To make sure programs deliver the treatment effectively and minimize the chance of fraud, California requires clinics go through extra training and inspections, and makes clinicians enter their results into a central database. Clinics also have to dedicate three staffers to the program, a workforce requirement that has forced some providers to delay starting the treatment or not participate at all.
So far, state officials have set aside $5.6 million to help clinics stand up their programs, and Sadwith is eager to reach more patients.
“We want to use this opportunity to prove to the public, to the field, to our federal partners, and to other states that this works,” Sadwith said. “People get better, and there is a role for contingency management in Medicaid.”
At least three other states — Montana, Washington and Delaware — are now running their own programs through Medicaid, and four others are seeking federal approval.
This story comes from the health policy news organization Tradeoffs. Ryan Levi is a reporter/producer for the show, where a version of this story first appeared. Listen to the story here:
A general view of the Olympic flame in the Olympic cauldron designed by Marco Balich next to the Arco della Pace monument in Milan.
(
Julien De Rosa
/
Getty Images
)
Topline:
The 2026 Milan Cortina Winter Olympics kicked off in Milan on Friday evening, local time. Athletes representing over 90 countries march into the San Siro stadium filled with thousands of spectators during the opening ceremony in Milan.
Read on ... to see photos from the 2026 Winter Olympics opening ceremony.
The 2026 Milan Cortina Winter Olympics kicked off in Milan on Friday evening, local time. Athletes representing over 90 countries march into the San Siro stadium filled with thousands of spectators during the opening ceremony in Milan.
The performance paid homage to Italian music, art and culture with tributes to composers, visual artists and films in a colorful spectacle. Performers included Italian actress Matilda De Angelis, American singer Mariah Carey, Italian singer Andrea Bocelli, Italian rapper Ghali and Italian ballet dancers Antonella Albano and Claudio Coviello, among dozens of other dancers.
Here is a selection of images from the opening ceremony:
Italian ballet dancers Antonella Albano and Claudio Coviello perform during the opening ceremony.
(
Wang Zhao
/
Getty Images
)
Colorful dancers perform under large tubes of paint suspended above them during the opening ceremony.
(
Gabriel Bouys
/
Getty Images
)
Italian actress Matilda De Angelis (center) performs with dancers dressed as the three great masters of Italian opera: Giuseppe Verdi, Giacomo Puccini and Gioachino Rossini.
(
Piero Cruciatti
/
Getty Images
)
Mariah Carey sings during the opening ceremony.
(
Wang Zhao
/
Getty Images
)
Performers dressed in the colors of the Italian flag line up during the opening ceremony.
(
Piero Cruciatti
/
Getty Images
)
Members of The Corazzieri, the Italian Corps of Cuirassiers, raise the Italian flag during the opening ceremony.
(
Wang Zhao
/
Getty Images
)
Two performers are suspended between two large rings.
(
Piero Cruciatti
/
Getty Images
)
The Olympic Rings are revealed above dancers during the opening ceremony.
(
Piero Cruciatti
/
Getty Images
)
An aerial view of the athletes parading into the San Siro stadium.
(
Antonin Thuillier
/
Getty Images
)
Stoats Milo and Tina, the Paralympics and Olympics mascots, dance before the Olympic opening ceremony.
Casey Wasserman, chairman of the Los Angeles Organizing Committee for the 2028 Olympic and Paralympic Games spoke during an IOC meeting ahead of the 2026 Winter Olympics, in Milan, Italy, on Tuesday. Wasserman faces calls to step down after it was revealed that he exchanged emails with Epstein collaborator Ghislaine Maxwell.
(
Luca Bruno
/
AP
)
Topline:
During the first days of the 2026 Milan Cortina Winter Games, the long shadows of Jeffrey Epstein and Ghislaine Maxwell spread to touch the Olympic movement. While in Milan, one of the top organizers of the 2028 Los Angeles Summer Games faced calls to step aside after his emails turned up in the latest tranche of Epstein documents released by the U.S. Justice Department.
The backstory: There's no indication of criminal wrongdoing in the emails, which were sent more than twenty years ago. But for a prominent figure like Wasserman, who heads an influential sports and entertainment agency, any association with the pair is fraught.
Read on ... for more on how the latest release of documents is casting a pall over the Olympic Games.
MILAN — During the first days of the 2026 Milan Cortina Winter Games, the long shadows of Jeffrey Epstein and Ghislaine Maxwell spread to touch the Olympic movement.
While in Milan, one of the top organizers of the 2028 Los Angeles Summer Games faced calls to step aside after his emails turned up in the latest tranche of Epstein documents released by the U.S. Justice Department.
"I will be in nyc for four days starting April 22...can we book that massage now," wrote Casey Wasserman in an email to Maxwell in the spring of 2003. A few days later, Wasserman said, "The only thing I want from Paris is you."
There's no indication of criminal wrongdoing in the emails, which were sent more than twenty years ago. But for a prominent figure like Wasserman, who heads an influential sports and entertainment agency, any association with the pair is fraught.
Wasserman has kept a low profile since news of his emails broke. He appeared publicly this week at a gathering of the International Olympic Committee (IOC) in Milan, where he touted progress developing the L.A. Games but didn't take questions from reporters.
In a statement, Wasserman said he never had "a personal or business relationship with Jeffrey Epstein" and he apologized for his flirtatious exchanges with Maxwell. "I am terribly sorry for having any association with either of them."
That hasn't quelled the controversy. A growing number of political leaders in L.A. have called for Wasserman to step down from his role as one of the leading public faces of the next Summer Games.
"Casey Wasserman should step aside immediately," L.A. City Councilmember Hugo Soto-Martinez said in a statement sent to LAist. "Anything less is a distraction and undermines efforts to make sure the Games truly reflect the values of a city that is for everyone."
L.A. city controller Kennith Mejia, who monitors the city's finances, said on social media that "Los Angeles cannot trust our financial future to someone connected with Jeffrey Epstein and Ghislaine Maxwell." Mejia added that "Wasserman must take accountability and resign."
Questions of Wasserman's future keep surfacing in Milan as the first sports competitions get underway. IOC chair Kirsty Coventry acknowledged at a press conference Thursday that she's been asked repeatedly about the scandal.
"Casey has put out a statement. I have nothing further to add on that," she said. Asked about the fact that Wasserman hasn't spoken directly with journalists, Coventry said, "I'll have them come find you guys and have a little chit-chat."
The head of the U.S. Olympic and Paralympic Committee, Gene Sykes, also faced repeated questions about the matter in Milan on Thursday.
"Casey's made a statement that reflects the perspective he has on what came to light, when the emails were released, with the rest of the Epstein file," Sykes told reporters. "We have nothing to add to that, his statement stands on its own."
Sykes went on to voice confidence in Wasserman's leadership. "I have more confidence today in L.A. 28's operational capabilities, its leadership, the quality of what its doing and how well they're executing than I've had at any point of time," he said, pointing to the L.A. bid's strong fundraising.
A long list of corporate executives, academic leaders, physicians, scientists, politicians, members of European royalty, and others, have been caught up in the Epstein scandal. A growing number of them have resigned, been fired, or been forced to step back from public life.
Keep up with LAist.
If you're enjoying this article, you'll love our daily newsletter, The LA Report. Each weekday, catch up on the 5 most pressing stories to start your morning in 3 minutes or less.
Actors Matthew McConaughey and Bradley Cooper appear in an Uber Eats ad linking football to a humorous food sales conspiracy.
(
Uber Eats
/
Screenshot by NPR
)
Topline:
A dive into the raft of ads airing in the Big Game that were released early, aimed at rocketing around social media to build buzz before their debut Sunday, revealed the typical mix of celebrities, nostalgia, special effects and bold humor we see every year.
What's new: New in the mix: A few efforts encouraging fans to build their own Super Bowl commercials, including an option from Uber Eats allowing users to make 1,000 versions of celebrity-filled ads and a contest sponsored by Artlist.io, an AI platform for video creation, offering $60,000 for the best subscriber-created spot.
Read on ... to take a look at some of this year's biggest ads.
If you're wondering whether it is truly worth the $8 million to $10 million cost per 30 seconds to air a commercial during the Super Bowl, just ask the creative minds behind the pro-Jesus advertising campaign "He Gets Us."
According to Come Near, the group managing the "He Gets Us" campaign, after airing commercials in three previous Super Bowls, they have seen nearly 10 billion video views, more than 70 million visitors to their website HeGetsUs.com and an awareness of the campaign so high that 40% of adults in the U.S. now know about He Gets Us.
And they expect that awareness to only expand with their fourth Super Bowl ad this Sunday titled "More," focused on the pressures many feel in modern society to pursue more of everything.
"There's not a lot of moments like this. … We're looking for moments where people really congregate," says Simon Armour, chief creative officer for Come Near, which has crafted the "More" ad as part of a campaign called "Loaded Words." "We're constantly asking, 'Are we really meeting people where they're at?'"
Offering a distinctly non-commercial message in the middle of the world's biggest advertising showcase is certainly one way to stand out. But that's only one of the many messages featured in an event that set a record last year — and the year before — as the most watched single telecast in U.S. history.
A dive into the raft of ads airing in the Big Game that were released early, aimed at rocketing around social media to build buzz before their debut Sunday, revealed the typical mix of celebrities, nostalgia, special effects and bold humor we see every year.
New in the mix: A few efforts encouraging fans to build their own Super Bowl commercials, including an option from Uber Eats allowing users to make 1,000 versions of celebrity-filled ads and a contest sponsored by Artlist.io, an AI platform for video creation, offering $60,000 for the best subscriber-created spot.
And, as we have seen in recent years, there's a decided lack of commercials offering any kind of sharp social message. At a time when America seems more divided than ever, most advertisers don't seem keen on spending millions to address the social or political issues of the day.
Of course, the most impressive messages may not surface until the Big Game itself. But here's a look at some of the most interesting commercials unveiled in advance, offering a look at the bold swings marketers are about to take on the biggest stage in media.
Best use of a self-deprecating celebrity, Part 1: Raisin Bran's 'Will Shat'
YouTube
One of the coolest things in modern pop culture has been to watch Star Trek icon William Shatner morph from an overacting, self-serious stick in the mud into a goofy celebrity who begrudgingly accepts that it's better to play along with his peculiar kind of fame rather than resist it. The 94-year-old comes full circle with this ad for Raisin Bran that deftly spoofs both the result of eating all that fiber, Shatner's roots in science fiction and the scatological word game people likely have played with his last name for eons, introducing him in the commercial as a character named Will Shat. My favorite moment: when he looks over at a pet and asks, "Is that dog a Shih Tzu?" As a bonus, the Shat-man even made news in real life, when paparazzi thought he was eating a bowl of cereal while driving (he was actually posing for a photo shoot.)
Most touching reference to Big Brother: Ring's 'Search Party: Be a Hero'
YouTube
Tell people that video doorbell company Ring can remotely link a bunch of cameras to look for something, and many may wonder if they've stumbled into a George Orwell novel. But show people how Ring cameras can be tasked to help find some of the 10 million dogs who go missing every year — using its new, free Search Party feature — and you have a teary, sentimental spot for the Big Game that pulls on the heartstrings while downplaying any concerns about Big Brother invading their privacy (fear not, Search Party is a program you have to opt into).
Best argument to Hollywood for using AI: Xfinity's 'Jurassic Park … Works'
YouTube
Cool as it is to suggest that one tech geek from Xfinity could have kept all the dinosaurs from escaping Jurassic Park, the telecommunication company went one better in this ad – basically showing the potential for de-aging and computerized imagery in film by creating new scenes for the 1993 movie featuring stars Sam Neill, Laura Dern and Jeff Goldblum. In Xfinity's new spot, they're jogging with herds of dinosaurs and posing for pictures with a T. rex instead of running for their lives. Of course, a happy ending invalidates the film's whole "egotistical man shouldn't meddle with natural ecosystems he doesn't understand" message. But it will probably sell an awful lot of Wi-Fi service.
Best use of a self-deprecating celebrity, Part 2: TurboTax's 'The Expert'
YouTube
Adrien's Brody's over the top antics while portraying a TurboTax expert – despite the company's insistence that the program helps keep taxes "drama free" — is a delicious send-up of his own self-serious reputation. (My fave moment is when he screeches "If there's no drama, then there's no Adrien Brody!") It's almost enough to make you forget the record-setting arrogance of his way-too-long best actor acceptance speech at last year's Oscars ceremony. Almost.
Best headfake around men's silly sensibilities: Novartis' 'Relax Your Tight End'
YouTube
What's the best way to let men know there's now a less, um, invasive way of checking for prostate cancer than the old school finger method? This commercial, featuring football heroes like former New England Patriots tight end Rob Gronkowski and former Tampa Bay Buccaneers coach Bruce Arians urges men to relax their tight end — complete with shots that seem to depict that relaxation — thanks to the invention of a blood test to check for early signs. It's all a bit of cheeky good fun — OK, I couldn't resist that one — aimed at getting men to get over their hangups and get tested regularly for a disease that has an impressive survival rate if caught early.
Best use of class warfare: Hims & Hers' 'Rich People Live Longer'
YouTube
Fresh off a controversy from last year, which found the telehealth company criticized for not being fully transparent about the side effects of its weight loss drugs, Hims & Hers is back with a spot that declares "the wealth gap is a health gap." Rapper and actor Common provides the voice-over for this spot, which shows wealthy people accessing all kinds of treatments and preventive care as the narration notes, "all that money doesn't just buy more stuff — it buys more time." Watching a big corporation spend millions pitching its products as an affordable way to bridge that gap, at a time when medical expenses are one of the leading causes of bankruptcy in the U.S., feels a little odd. But it's also a stroke of genius.
Best parody of a competitor: Pepsi's 'The Choice'
YouTube
This spot, starting with a computer-generated polar bear getting confused after picking Pepsi over Coca-Cola in a blindfolded taste test, works in all kinds of ways. It pokes at Coke's longtime use of computerized bears in its own Big Game ads back in the day while indulging a bit of nostalgia. Extra points for a moment later in the ad that references the infamous Coldplay kiss cam incident and a cool cameo from impish director Taika Waititi.
Most questionable joke: DoorDash's 'Beef 101'
YouTube
In the ad, 50 Cent presents the latest iteration of his beef with Sean "P Diddy/Puff Daddy" Combs as an epic exercise in tongue-in-cheek trolling. He reaches into a DoorDash pouch to pull out a bag of Cheesy Puffs, a pack of combs and a bottle of cognac he says is "aged four years … or 50 months. Who's keeping count?" But I bet Combs, now sitting in federal prison after his conviction on prostitution-related charges, surely is. And those who recall the allegations of sex crimes and abuse which surrounded the Combs trial, might not find a commercial seeking laughs by referencing that traumatic situation to be much fun at all.
Most shameless pandering to bro culture: Bud Light's 'Keg'
YouTube
Football legend Peyton Manning, comic Shane Gillis and musician Post Malone seem mostly wasted in a nonsensical ad featuring an entire wedding party tumbling down a steep hill in pursuit of a single keg that fell off a dolly. Gillis gets the punchline, turning to the camera to say, "I give it a week," presumably in reference to the wedding. I'm betting most viewers forget about this uninspired ad even quicker.
Best use of a conspiracy theory I might actually believe: Uber Eats: 'Hungry for the Truth'
YouTube
This spot continues the concept Uber Eats floated in last year's Super Bowl ad, featuring Matthew McConaughey insisting the NFL organized this whole professional football thing as a ruse to sell more food. This time, he's torturing poor fellow movie star hunk Bradley Cooper — who mostly looks like he just wants to be seen wearing gear featuring his beloved Philadelphia Eagles — pointing out all the NFL players named after food. But when he shows Cooper that the NFL Hall of Fame building looks just like a juicer — gotta say, I was nearly convinced.
Fiona Ng
is LAist's deputy managing editor and leads a team of reporters who explore food, culture, history, events and more.
Published February 7, 2026 8:46 AM
Three people are dead and several others are injured after a woman crashed her car into a 99 Ranch Market in Westwood.
(
Courtesy CBS L.A.
)
Topline:
Authorities have released the identities of two of the three people killed in Thursday's car crash into a 99 Ranch supermarket in Westwood. One of the deceased is 42-year-old woman Deris Renoj. The other is Zih Dao, a 28-year-old man.
Two of the victims are employees at the Chinese super market, while the third is a customer. Authorities did not release additional details associated with the two names.
The backstory: The deadly crash happened around noon Thursday, when a sedan driven by a 92-year-old woman rammed into the grocery store on Westwood Boulevard after hitting a bicyclist and losing control of the car. Additional people were injured.
