Latest developments in causes and treatments



Seattle Testing Contingency Management for the Treatment of Substance Use Disorders

According to an article in The Seattle Times, Washington State is one of only two states in the country where contingency management programs have been authorized by Medicaid and Medicare, the other state being California. Contingency management, or CM, is the practice of paying people to abstain from tobacco, drugs, alcohol, and certain behaviors.

CM has been shown to have the best track record of any addiction treatment. By paying people to pass a drug test to prove their abstinence, more people start treatment, more people complete treatment, and more people stay sober weeks, months and years later. The Seattle CM program is being run in conjunction with Plymouth Housing, a housing-first community for the unhoused in Seattle.

Plymouth Housing is one of the most amazing success stories in the decades-long effort to deal with urban homelessness. Founded in 1980 by Rev. David Colwell and members of the Plymouth Congregational Church, Plymouth Housing is an independent, nonprofit organization devoted to developing housing solutions for the homeless.

Plymouth Housing owns more than a dozen apartment buildings in Seattle and one in nearby Bellevue. With more than 1,200 residents, they practice a philosophy of harm reduction, including reducing the negative impacts of substance abuse.

For Plymouth Housing, harm reduction means they do not insist on abstinence and they are ready, willing and able to assist in providing treatment for those who want it, for as long as they need it. As Plymouth Housing’s behavioral health manager, Aaliyah Bains, told The Seattle Times

We’re not asking them to be 100% sober, we’re asking them to meet the goals they set for themselves.

In the decades Plymouth Housing has been providing housing, it has come to add many other services to keep people housed and healthy. Support services now include:

  • On-site nursing and medical care
  • Behavioral health treatment
  • Substance use treatment
  • Hospice care
  • Veterans counseling
  • Family reunification
  • Money management programs
  • Community activities and outings

To provide this continuum of care, Plymouth Housing has partnered with area hospitals to put clinics into its facilities. These clinics will now be administering the CM program of financial rewards for staying in treatment. Monitoring the program is Washington State University’s Eldon S. Floyd School of Medicine.

The Floyd School made the news recently with one of the most rigorous studies yet on the effectiveness of CM. The Floyd School is the home of the Program of Excellence in Addictions Research, or PEAR. They tested CM in a randomized trial with 507 adults in 10 outpatient facilities. The trial was 12 weeks long and participants were re-evaluated after 24 weeks and 36 weeks. The results proved the savings to insurance companies of funding CM for substance use disorders.

The Seattle pilot program with Plymouth Housing involves Safeway gift cards for participating in treatment. One of the reasons residents are attracted to the program is they can get treatment on-site, without having to go to an outside therapist or other medical provider, thus reducing barriers to starting treatment.

Seattle continues to struggle with a hundred overdose deaths every month. As we reported here on AddictionNews, most of the deaths are caused by a combination of fentanyl and other substances including synthetic opioids. Seattle is working to lower the mortality rate with a mobile methadone clinic and a new behavioral health center, according to The Seattle Times

“Initial anecdotal evidence from the Plymouth program shows promise,” writes David Kroman, who covers City Hall for The Seattle Times. We’ll be sure to follow up on this pioneering trial of contingency management.

Written by Steve O’Keefe. First published June 12, 2024.


“Seattle tries new approach for treating addiction — gift cards,” The Seattle Times, June 6, 2024.

Image Copyright: A Boy and His Bike, used under Creative Commons license.


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