He Was Paid $7 for a Clean Test. What He Heard Was 'Good Job.'

Billy Lemon had been arrested three times for selling meth before he walked into the San Francisco AIDS Foundation three days a week to pee in a cup. Each clean result paid about $7. After 12 weeks of them he walked out with $330, the most legitimate money he had held in years. “For somebody who had not had any legitimate money — without committing felonies — that seemed like a cool thing,” he told KQED’s April Dembosky.

The reporter noticed something the dollar figure doesn’t explain. The payments meant more than money. They were also someone telling him, “Good job.”

The money is the part people argue about. The gladness is the part that does the work, and nobody budgets for it.

Think about the last time somebody noticed you doing something right. If you have been in active use, the answer might be a long time ago, and the people around you may have spent years bracing for the next thing you’d get wrong. Groves lost his job and his car and nearly his apartment, and the people around him had good reason to brace. A program that meets you three times a week, tests you, and reacts with visible gladness is offering a small, repeating, immediate answer to the question a person in that spot is asking, which is whether anyone would even know if you stopped.

Bernard Groves, 35 and having spent five years trying to quit meth, described the other side of it to Tradeoffs. Earlier rehab had felt like people “talking at” him. His gift cards bought weights, food for his bird, and a movie night with his mom, his sister and his grandmother. “Being able to treat my family and do things for them is special,” he said. Notice what he spent it on. Not the thing he’d quit. The people he’d been missing.

None of this means a $10 gift card is a miracle. California’s program caps out at $26.50 a test and about $599 over six months, though most studies show it works best when people can earn over $1,000. And a September randomized trial in Denver found that rewards raised how often people showed up to a navigator but did not significantly raise how many reached treatment, a trial we pick apart in our Arizona piece. Showing up is the first half. Someone has to be at the other end of it.

If you are using and you are reading this, you do not have to earn being noticed. Ask the next clinic you walk into if they do contingency management. If they say no, ask them if anyone there can be glad to see you anyway. It is a strange thing to need, and an ordinary one. Lemon said as much. So did Groves. You are in decent company.