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

On Friday, Southern California Edison filed lawsuits against Los Angeles County and several other agencies over their alleged roles in the Eaton Fire.

Two lawsuits were filed.

In one suit, the utility company alleges Southern California Gas delayed shutting off gas in the burn area for several days after the fire, making the blaze worse.

“SoCalGas’ design and actions caused gas leaks, gas fires, reignition of fires, gas explosions and secondary ignitions during the critical early stages of the Eaton Fire,” according to the suit.

The claim goes on to say this contributed to the spread of the fire and made firefighting and evacuation efforts more difficult.

In the second suit, the utility company alleges the Eaton Fire was made worse by the local government response, “including due to the failures of LASD, LACoFD, OEM and GENASYS in issuing timely evacuation alerts and notifications,” the claim reads.

The same filing says L.A. County was to blame for vegetation and overgrown brush in the Eaton Canyon area that fueled the blaze.

It also named the city of Pasadena and its utility system, Pasadena Water and Power, the city of Sierra Madre, Kinneloa Irrigation District, Rubio Cañon Land & Water Association, Las Flores Water Company and Lincoln Avenue Water Company as parties responsible for water systems running dry in Altadena as the fire broke out.

Edison says hydrants running dry compounded the extent of the disaster.

Those claims will be heard in the L.A. County Superior Court, which is also handling L.A. County’s lawsuit against SoCal Edison.

Edison itself is the subject of hundreds of lawsuits from survivors of the Eaton Fire, which could cost the company billions of dollars in settlements.

Edison has said its equipment likely sparked the Eaton Fire and filed these suits, in part, because it believes these various entities should share some of the blame for the disaster, which resulted in the destruction of thousands of buildings and the deaths of 19 people.

A compensation program Edison established for fire survivors who forgo suing the company has made settlement offers to more than 80 of those who applied.

A new organization is taking over production of the MLK Day Parade, almost 40 years after the first parade was held in South L.A. to commemorate the civil rights leader.

Bakewell Media, publisher of the Los Angeles Sentinel newspaper (a partner of The LA Local), was granted the permit in September to organize the parade for the first time by the Los Angeles Board of Police Commissioners. Formerly called the Kingdom Day Parade, the parade has been rebranded as the Los Angeles Official Martin Luther King Day Parade. The parade was previously produced and organized by Adrian Dove and the L.A. chapter of the Congress of Racial Equality California (CORE-CA).

With less than a week before the parade kicks off, LA Local reporter LaMonica Peters sat down with Danny Bakewell Jr., president and executive editor of the LA Sentinel, to discuss the details and what attendees should expect.

This Jan. 12 interview has been edited for brevity and clarity.

Why did you decide to produce the MLK Day Parade this year?

Bakewell: It all started because Adrian Dove, who was the previous promoter, had announced that he was retiring. When he announced he was retiring, LAPD, city council offices and other people said, “Hey, we still want to do the MLK Day parade. Would you guys be interested? You have the infrastructure to put it together.” And we said yes.

What’s different about this year’s production?

We’re going to start the parade with a singer performing “Lift Every Voice.” We’re going to play the message from Bernice King at the start of the show. Obviously, we have Cedric the Entertainer as our grand marshal to add the entertainment value, but the community has always been and will continue to be a major part of this parade.

Is ABC 7 covering the parade this year? 

It’s still going to be televised by ABC. We’re working diligently on how the show is going to be, but ABC has been a great partner.

What was the preparation for this parade?

Thanks to our corporate sponsors, we have a number of bands. The truth is, particularly in LAUSD at this time, and other school districts, they don’t have the funding to just get a bus and get here. I can’t say enough about Airbnb to Bank of America, all of our corporate sponsors, who are supporting all of the youth organizations.

Were there any unexpected challenges while preparing for this parade? 

This [The LA Sentinel office on Crenshaw Blvd.] is usually our command center during The Taste of Soul. It dawned on me last week that we’re going to be a mile away [from the parade route]. So, we made the decision to bring in a trailer to be our office at the corner of King and Crenshaw boulevards.

Any special guests this year besides the grand marshal?

I’m working on a surprise guest to be the singer for the national anthem. No matter what, we will give tribute to the Black national anthem “Lift Every Voice” as loud as we can next Monday.

What’s the long-term vision for this parade, if Bakewell Media continues to produce it?

We see the MLK Day Parade, and we want the world to see and expect to see this parade, the same way they see the Macy’s Parade, the Hollywood Parade or the Rose Parade. BET has come in this year as a partner. So there’s an opportunity to possibly do a national broadcast on BET. Not that we would lose our local television, but we see this as a major parade in this community and in the national African American community, celebrating the great work of Dr. Martin Luther King Jr. So, we are very excited.

Bits of conversation drift out of Aladdin Used Books as people lined up at the register with stacks of books.

The bustle of activity is bittersweet as the Koreatown bookstore will close its doors at the end of January after 13 years in the neighborhood.

Jina Lee, store manager, said declining sales at the Koreatown branch led to the decision to close the store. In recent years, staffing at the 5,000-square-foot store on the third floor of Madang Mall dropped from six to two, Lee said.

“This was a happy place for everyone,” she said, “but we were struggling.”

On a recent January afternoon, the shop looked lively as customers took advantage of the clearance sale on Korean and English books, CDs, DVDs and other media.

Koreatown resident Jin Lee wishes he visited the bookstore more often.

“It would have been great if it had been this crowded all the time,” Lee said. “But nowadays, people don’t read paper books and prefer devices, so it’s hard for all bookstores.”

Some customers traveled from as far as Orange County and the Inland Empire to visit one last time.

Minjung Kim, who moved from Koreatown to Fullerton five years ago, still made trips to the bookstore after she moved away.

“It’s the only place that sells this many new and used Korean books,” she said.

Each visit to the bookstore was important to David Artiga of Pomona, because it gave him a chance to connect with friends over literature.

“I feel like this is really negative for the community,” he said. “The importance of having a well-versed society, keeping in touch with literature and art is so important. And now this place is just going to be gone.”

South Korea-based Aladdin Used Books opened its first U.S. brick-and-mortar store in Los Angeles in 2013. The store carries around 50,000 new and used books, with a majority in Korean.

Customers will still be able to order books through Aladdin’s website after the store closes.

Ken Derick, a Koreatown resident, walked around the store aisles with a stack of books.

“It’s like we’re kind of moving towards a new technology, like everything’s virtual and online,” he said.

Longtime customer Anthony Kim said he’s enjoyed looking for gems in the English-language shelves.

“My Korean ability is rather limited but I’ve always enjoyed browsing their English language sections,” he said. “And now that I have a niece and nephew, their children’s book section has always been a great place to pick up new books for them.”

Valerie Laguna perused the shop’s CD section, a bygone experience in the era of streaming.

“I really like their CD collection and their literature collection they have in English,” she said.

“I was so sad about it, I immediately texted my friend,” she said. “I’ve gotten so many of my favorite books and my favorite CDs from this place. I feel like losing a place like this is just so sad and makes a huge dent in the community and culture.”

Less than a mile away on Western Avenue, Happy Bookstore owner Jung Jae-seung said it has been difficult for bookstores for some time now. His Korean-language bookstore is also struggling in an era when so many people have abandoned print media.

“It’s really about how long printed books can survive,” Jung said. “From that point of view, it’s hard to be optimistic.”

South L.A. or South Central? More than 20 years ago, that question came with high emotions for some residents who were sick of the stereotypes they saw in media coverage of their neighborhoods.

So in 2003, the Los Angeles City Council renamed the collection of communities south of the 10 freeway in an attempt to cut ties with the connotations of poverty and crime that some believe came to represent South Central after the turbulence of the 1980s and ‘90s. Today, you see South L.A. on official documents, maps and even historical and cultural districts.

Even though city officials moved to wipe away the old name, some locals never stopped calling the area South Central — a name that for them represents history, resilience and Black and Latino culture.

“I think it will always be South Central for its residents and for the people that were born and raised here,” said Evelyn Alfaro-Macias, a social worker who was raised in Historic South Central and whose office is on Hoover Street. “It means home. It means culture. People should respect the name South Central.”

What and where is South LA, anyway?

By the early 2000s, television news and pop culture had given South Central a reputation for violence and chaos that some were eager to shake.

Helen Johnson, a resident of Vermont Square, helped lead the campaign to change the name.

“I think the media can make you or either break you,” 72-year-old Johnson told reporters in 2003 after the city council approved the name change, according to the L.A. Times. “This is what you’ve done to us. You’ve broke us.”

Supporters of the change included then-Councilmember Janice Hahn, who is now a county supervisor and said at the time that the South Central name had become “mostly derogatory.”

L.A. Mayor Karen Bass, who was working then as executive director of the nonprofit Community Coalition, said the area’s image problem wasn’t just about its name.

“If the media paid a little more attention to covering positive things in the community, that will also help,” Bass said, according to an L.A. Times report.

The LA Local has reached out Bass and Hahn’s offices, as well as L.A. City Council President Marqueece Harris-Dawson.

The exact borders of South Los Angeles, or the area formerly known as South Central, are fuzzy.

The South Central name originally only applied to the neighborhood around Central Avenue south of downtown Los Angeles, but it spread west as populations grew.

City planning documents today designate a strip of neighborhoods between Interstate 110 and Arlington Avenue as South Los Angeles and tag the Central Avenue neighborhood as Historic South Central. Others, including academics and the city tourism board, use a map of South Los Angeles that stretches to the border of Culver City.

This is what the community told us

Some businesses in the area adopted the South L.A. name, notably South LA Cafe, the coffee shop that has grown to five locations and become a local institution.

More recently, some groups have made a concerted effort to embrace South Central, like the South Central Run Club or South Central Clips, an Instagram-based group that sells skatewear-inspired “South Central” apparel. (Even South LA Cafe today sells some merch with the South Central name.)

Several locals told The LA Local the official designation never changed anything for them.

“It’s South Central for me. That’s where my roots are,” April Brown said. “When you go anywhere across the country, across the world and you say South Central, they know exactly what you’re talking about.”

To Emily Amador, the name change erases the history of South Central, including “the Black migration that occurred, redlining that created what we know today to be South Central and the demographics, which are here today, which is Black and brown and undocumented.”

Ulysses Alfaro, who was born and raised in the Historic South Central neighborhood, said he uses South L.A. with people from out of town but South Central with locals.

South L.A. is a geographic designator, he said, but he considers South Central to be an identity: “That’s where the grinders are, the hard-working people that work their butts off, their asses off. The ones that keep the city running.”