The Brief

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.

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‘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:

Copyright 2024 TRADEOFFS

Eric Swalwell, who had emerged as one of the top candidates in California’s crowded governor’s race, suspended his campaign Sunday evening after a series of women accused him of sexual assault and harassment, including allegations that he raped a former staff member twice.

In the short statement posted on social media, he did not address whether he will remain in Congress.

Swalwell, a married father of three who represents the East Bay, faced swift calls to resign from his House seat and leave the governor’s race after the allegations were published by the San Francisco Chronicle and CNN on April 10. In addition to the political fallout, he’s now facing a criminal inquiry from the Manhattan District Attorney’s Office in New York and possibly Alameda County — where the 2024 and 2019 alleged assaults each took place.

“To my family, staff, friends, and supporters, I am deeply sorry for mistakes in judgment I’ve made in my past,” Swalwell said on X. “I will fight the serious, false allegations that have been made — but that’s my fight, not a campaign’s.

The reports by the Chronicle and CNN included allegations by an unnamed former staffer who said Swalwell sexually assaulted her when she was too intoxicated to consent in both 2019 and 2024. CNN also reported allegations of misconduct from three other women involved in Democratic politics, including one who said Swalwell kissed her without consent and two others who said that he sent them unsolicited nude photos and explicit text messages.

Swalwell flatly denied the allegations of sexual assault in a video he posted on social media Friday, and vowed to fight them. But he seemed to acknowledge at least some infidelity, adding that any mistakes are between him and his wife, and apologizing for “putting her in this position.”

But within hours of the stories publishing, Swalwell was abandoned by nearly all his supporters. Top House Democrats, including Minority Leader Hakeem Jeffries and Speaker Emerita Nancy Pelosi, called for his exit, and he lost 21 endorsements from fellow Democratic members of Congress.

Over the weekend, senior staffers from both his congressional office and campaign resigned, and major labor groups like the California Teachers Association and SEIU California pulled their support. His campaign website no longer contains links to donate or a page listing his donations.

In a joint statement Sunday, 55 of Swalwell’s former staff members called the allegations “serious” and “credible” and urged law enforcement to investigate. They also called on Swalwell to resign from Congress and withdraw from the governor’s race, and apologized to their former colleague “for not knowing what you were enduring.”

“We believe her,” the letter states. “What has been described is not a political attack. It is the account of a young woman who trusted her employer, who was targeted and exploited by someone in a position of power over her, and who has carried this burden for years.”
Swalwell, 45, had a meteoric rise in politics — and a fall that came just as fast. A former Alameda County prosecutor, he first ran for Congress in 2011, as a 30-year old Dublin city councilmember who unseated a 20-term incumbent nearly 50 years his senior.

He rose to national prominence during President Donald Trump’s first term when he was tapped to help investigate Trump during both impeachment inquiries. The roles — as an impeachment manager during the first impeachment, and again as a House manager during the second — led to frequent appearances on cable news and made him one of the Democratic Party’s most high-profile Trump critics.

He briefly ran for president in 2019, but dropped out within months after failing to gain traction. Swalwell announced a run for governor in November, joining a crowded field to replace the termed-out Gov. Gavin Newsom. Other leading Democrats include former Rep. Katie Porter and billionaire Tom Steyer, though the race had remained wide-open and a clear Democratic favorite had yet to emerge.

Over the past five months, Swalwell quickly amassed endorsements from most of his congressional colleagues, state lawmakers and some of California’s largest labor unions. They all abandoned him after the allegations were made public.

Republican Leticia Castillo stunned political observers when she won her Riverside County Assembly seat in the state Legislature two years ago.

The Democratic candidate, Clarissa Cervantes, the sister of the outgoing assemblymember, was favored and had spent more than 10 times as much as her.

This year, Castillo thinks she can do it again.

“I’m accessible to my constituents and they like that,” Castillo said at an evening reception outside a San Diego resort. Republican strategists, legislators and advocates are meeting for the party’s annual convention in downtown San Diego, one month before mail ballots for the June primary appear in mailboxes.

California Republicans are optimistic Castillo and a handful of other GOP legislators can hold onto their seats — but only if they keep President Donald Trump at a distance. It’s emblematic of a tension between leaders who are focused on strategic campaigning and party conservatives’ unabashed embrace of Trump. GOP candidates have been careful not to align themselves too closely with the president, whose affiliation can activate California Democrats to vote against anything from a candidate to a ballot measure.

Inflation and America’s entry into another war have cratered the president’s popularity among voters nationally. And the California party is listening. Officials over the weekend repeatedly downplayed him and his influence in state politics. But between bedazzled sweaters featuring his name and cardboard cut-outs of him, delegates’ support for the president was on full display.

Trump remains deeply unpopular in California. But his support among hard-line conservatives activists has rarely, if ever, wavered since in the last decade. That remains true among California Republican activists, whose devotion has not waned despite Trump’s controversial decision to enter a war with Iran that has caused record-high gas prices.

“I love what he’s doing. I love all the s— he’s saying,” Los Angeles delegate Mary Boston said about Trump and the war in Iran. “The whole establishment — all the Democrats, all the judges — they just hate him because he’s trying to make a difference for you and me.”

Donald who?

However, GOP officials sought to minimize his role.

“I think people here are tired of California. They know that the federal government is doing nothing to harm or help California,” Riverside County sheriff and Republican candidate for governor Chad Bianco said in an interview. Trump last week endorsed his Republican rival Steve Hilton, a former Fox News host, instead of Bianco. “For the last week, people haven’t cared what President Trump is doing,” he said of Trump’s endorsement.

Bianco and Hilton have been reticent to mention Trump. In a state where Democratic voters vastly outnumber Republicans, it’s an imperative.

State party Chair Corrin Rankin said she was surprised to see Trump “weigh in on anything in California,” and refused to comment directly about voters’ discontent with his policies.

Some party leaders are hoping Trump’s toxicity will just blow over come the June 2 primary.

“Just as quickly as the gas prices went up, I think that we’ve all seen in California how quickly gas prices can also come down,” state party Vice Chair John Park said. “Many of the problems that are on the front burner, the ones that people will instinctively tie to President Trump, will subside by then.”

At the convention, the divide between the party establishment and its rank in file was on display. Trump merchandise could be seen all across the convention — at vendor booths, on the walls and on people’s clothes. At some sessions, Trump’s footprint was large. A “Make California Great Again” session was spearheaded by Jo Reitkopp, from Orange County, who founded a group of the same name shortly after Trump was inaugurated in 2016.

Reitkopp and other party activists were advocating for a voter ID ballot initiative that would require voters to show proof of citizenship to vote. The ballot measure is modeled after a voting restriction bill Trump is pushing in Congress.

Running for the Legislature? Stay mum on Trump

Even before voters passed Proposition 50, the ballot measure targeting House Republicans, the California Republican Party was weak and had little relevance. Democrats continue to hold a commanding supermajority in Sacramento, where Republicans are fewer than a third of state lawmakers. No Republican has been elected to a statewide office since 2006.

Things briefly looked different in 2024 after voters shifted to the right in nearly every county as part of the backlash to President Joe Biden. Predominantly Latino and working-class voters in Imperial County backed Trump, the first time they had backed a Republican presidential candidate in decades. Republicans also flipped three seats in the Legislature, a first in 10 years.

Those trends quickly evaporated. Voters in Imperial County and across the state overwhelmingly approved Prop. 50, complicating the narrative that Democrats were losing Latinos in California.

Imperial County GOP Chair Sayrs Morris said candidates’ approach will be to keep mum on Trump because of voters’ frustration with the economy.

“We’re not going out there saying our candidates are MAGA candidates. We’re keeping it focused on them,” said Morris, a Trump supporter. “Right now things are tough. The economy’s not super great. And we’re at war.”

Coachella Republican Assemblymember Jeff Gonzalez will be a test case. He flipped his district two years ago, despite a registration advantage that favors Democrats by 12 percentage points. Among Gonzalez’s challengers are Indio city Councilmember Oscar Ortiz and former El Centro Mayor Tomás Oliva. So far, he’s outraised all of them with $630,000 in his campaign account at the end of last year.

Gonzalez’s campaign spokespeople did not return calls and emails seeking comment.

Republicans are also targeting Castillo’s Riverside Assembly seat and Senate Minority Leader Brian Jones’ San Diego district, where the GOP holds only a slight advantage as voters in north and eastern parts of San Diego County trend leftward. He terms out at the end of this year.

“It’s the one we’re all watching,” GOP activist Justin Schlaefil said.

The debate over who should succeed Jones, a moderate Republican, has been a tension point among Republicans in San Diego.

Jones and U.S. Rep. Darrell Issa have backed San Marcos City Councilmember Ed Musgrove. Meanwhile, Reform California, a multimillion-dollar political organization led by Republican Assemblymember Carl DeMaio, is supporting Kristie Bruce-Lane, a two-time unsuccessful Assembly candidate who is further to the right than Musgrove.

Moderate Republicans fear Lane is too conservative for what will be the most competitive district this year.

Neither candidate gained enough support for an endorsement at a February San Diego County GOP meeting after hours of heated debate.

“We’re spending a lot of money against each other just because of that,” said Schlaefil, a friend of Jones. “It is winnable, but it is very tight.”

Back in Riverside, Castillo has a much larger war chest than two years ago when she narrowly clinched her seat by a few hundred votes against Democratic City Councilmember Clarrissa Cervantes.

Cervantes was initially considered a shoo-in. But she was bogged down by two DUI convictions. Cervantes attributed her loss to poor Democratic turnout. This time, she hopes things will be different.

Castillo is keeping her focus on public safety and parental rights.

“I get people just want to continue to say, ‘Trump, Trump, Trump,” she said. “At the end of the day, we’re in California, and Trump doesn’t rule here.”

Los Angeles Unified reached deals with some of its biggest labor unions on Sunday, ahead of a planned April 14 strike that would shut down the district.

On Sunday morning, LAUSD announced a deal with United Teachers Los Angeles, whose members include 35,000 teachers and counselors. In the evening, district officials announced an agreement with Associated Administrators of Los Angeles, which represents 3,000 principals and other school leaders.

But educators are expected to honor possible picket lines on Tuesday if a deal can't be reached with the remaining union in negotiation, SEIU Local 99. That union represents bus drivers, classroom aides and other staffers.

“Despite [United Teachers Los Angeles] having reached a tentative agreement with the school district, teachers have pledged to stand in solidarity with SEIU Local 99 and join in a sympathy strike," SEIU Local 99 said in a news statement on Sunday.

An LAUSD spokesperson said negotiations are continuing into Sunday evening.

The three unions gave the district an April 14 deadline to reach agreements or else face a walkout. A strike could shut down district schools and disrupt the education of about 400,000 students and the lives of families scrambling for child care.

What are the terms of the UTLA deal?

LAUSD and UTLA announced a tentative two-year agreement. UTLA’s bargaining team had met with the district more than a dozen times since negotiations began in February 2025.

Terms of the new contract include an increase in salary scales by 11.65%, a new-teacher salary of $77,000 per year, four weeks of district-paid parental leave, expanded student mental health supports and a first-ever 20:1 ratio for special education specialist teachers.

“These wins reflect the progress we’ve fought for, enabling educators to stay fully focused on supporting students’ learning and well-being,” said Cecily Myart-Cruz, the union’s president, in a statement.

A district spokesperson told LAist the ongoing cost of the agreement with UTLA is $650 million and also includes “a comprehensive agreement on inclusive practices and staffing,” reduced secondary counseling ratios and smaller ratios for 11th- and 12th-grade academic class sizes.

The union’s members and the LAUSD Board of Education must vote to approve the deal. UTLA said in an Instagram post that its bargaining team "enthusiastically recommends" that union members ratify the new contract.

Learn more about the proposals UTLA made.

What are the terms of the AALA deal?

Major details of the AALA deal weren't immediately available Sunday, other than that it increases members’ salary by 11.65%, only a touch shy of the 12% the union had sought.

A strike would have been a first for the union, which affiliated with the Teamsters in 2024.

The union declared an impasse in February, an assessment the district disagreed with, but it agreed to continue negotiating.

“We don't have the necessary resources to really say we have safe schools, to really say that we're servicing students,” said Maria Nichols, president of AALA, during a pre-strike rally.

What is the staff union negotiating for?

SEIU Local 99 declared an impasse in December. The state appointed a mediator to try to help the two sides reach an agreement. The negotiating teams were scheduled to continue bargaining on Sunday.

The union's 30,000 members include bus drivers, cafeteria workers, classroom and campus aides. The contract expired June 30, 2024.

The union’s proposals include: 

• A 30% wage increase over three years. 
• More hours for workers who don’t have enough to qualify for benefits.

LAUSD’s most recent offer includes: 

• A 13% wage increase over three years.
• A task force that includes SEIU Local 99 members to advise the district on artificial intelligence use.
• Learn more.

SEIU Local 99 reports its members make an average of $35,000 a year.

Maria Avalos is a supervision aide at Fernangeles Elementary School in Sun Valley. Avalos said she’s only assigned four hours of work a day and also cleans houses and sells tamales to support her daughter.

“We need more hours,” Avalos said. “I live in an apartment that has one bedroom for 10 of us.”

What happens if schools close?

If a deal can't be reached with every union and a strike shuts down schools, LAUSD plans to distribute food, tech support and refer families to community organizations for child care. Updates about resources and labor negotiations will be posted to a dedicated website in English and Spanish.

However, during a three-day 2023 strike, families struggled to find care and access their child’s education.

Senior editor for education Ross Brenneman contributed to this story.