Retraining the brain with praise and prizes

Also: How much are obesity medicine shortages actually easing? [❤️ Donate]( [View in Browser]( September 10, 2024    Hi CommonHealth reader, I want to tell you about an impressive young man I met a few weeks ago. I'll refer to him by his first initial, "V," to make sure sharing his story doesn't derail his dream of becoming a firefighter V is 24, shy and very thin. His family is from Cape Verde. He works in a warehouse. And he is in treatment for addictions to both cocaine and fentanyl. Four years ago, V was buying fake pain pills and cocaine on the streets in Brockton to relieve depression and anxiety. He became suicidal. One day, he dragged himself to the Brockton Neighborhood Health Center and broke down in a doctor's office. "I didn't know what I was using, what addiction was, what was happening to my body or anything," V recently told me. "I was scared because I couldn't stop." The doctor sent V to the health center's outpatient addiction treatment program. V got on Suboxone to curb his addiction to the pain pills, which turned out to be fentanyl. But there's no approved medication to treat an addiction to cocaine - or any other stimulant. V would stay off drugs for a while, then relapse. "I have a lot of patience," said Rosali Santiago, the nurse who managed V's care and kept reaching out when V didn't show up. Then, about two years ago, V started something called "contingency management" to treat his addiction to cocaine. Contingency management aims to rewire the brain, replacing a drug-induced dopamine rush with one triggered by the pleasure of achieving a weekly goal and earning a prize. V's initial weekly goals were to stop using drugs. If a drug test showed no traces of cocaine, V got to spin a bingo-style drum until a folded slip of paper dropped out with his weekly reward written inside. Prizes might be small, perhaps a sticker that said "good job" or "you can change the world." But there were also medium-sized items like journals, craft kits or backpacks. On rare occasions, patients might win a larger item such as a tablet or headphones. Santiago tries to stock prizes she knows her patients will like. And she wants to encourage them to take good care of themselves, so her cabinet has a lot of scented lotions, candles and shower gels. Patients can't accumulate more than $75 a year in prizes. Anything more might put the program at risk of violating federal kickback laws. Contingency management didn't work for V right away. In that first year, he'd sometimes hit his weekly goal of not using drugs, then relapse. V still occasionally missed one of his three weekly appointments: for Suboxone, contingency management, or with his counselor. But there are no penalties in contingency management. Every week is a new start. The motivation from meeting goals and getting rewards slowly took hold.  Today, V hasn't used cocaine in a year. He's set and achieved other goals - going back to school, getting a job and taking better care of himself. V. also has a garden now, and is using some of the prizes he earned (a griddle, blender and hot plate) to teach himself to cook. He said contingency management helped him stop both cocaine and the pain pills. "It got me to think of ways I could do better, ways I could not use," V said. " 'cause when I'm at home, my mind is, 'Oh, how can I get the next prize? What's my next goal?' " These days, V said he mostly feels great. It was moving to see how praise, pride and some rewards helped turn his life around. It felt both basic and profound. Yet, contingency management is not available in most states, including Massachusetts, even as overdose deaths from stimulants rise. I'll have more on why and what's ahead in a story out later this week.  Martha Bebinger Reporter, Health This Week's Must Reads [Drugmakers say obesity medicine shortages are easing, but patients struggle to fill prescriptions]( The drug companies behind blockbuster weight loss and diabetes treatments have signaled that supply problems could soon be over, but many patients still have trouble getting the medicines. [Read more.]( [Drugmakers say obesity medicine shortages are easing, but patients struggle to fill prescriptions]( The drug companies behind blockbuster weight loss and diabetes treatments have signaled that supply problems could soon be over, but many patients still have trouble getting the medicines. [Read more.]( [Members of Mass. congressional delegation call for contempt vote after Steward CEO declines to testify]( Sens. Ed Markey and Elizabeth Warren pledged action against Steward Health Care's chief executive, Ralph de la Torre, for refusing to discuss the hospital chain'sbankruptcy. [Read more.]( [Members of Mass. congressional delegation call for contempt vote after Steward CEO declines to testify]( Sens. Ed Markey and Elizabeth Warren pledged action against Steward Health Care's chief executive, Ralph de la Torre, for refusing to discuss the hospital chain'sbankruptcy. [Read more.]( [First case of bird flu not directly linked to sick animals is found in Missouri]( So far, there have been 14 human cases of bird flu this year. All the patients - except the one from Missouri - had been linked to sick dairy cows or poultry. [Read more.]( [First case of bird flu not directly linked to sick animals is found in Missouri]( So far, there have been 14 human cases of bird flu this year. All the patients - except the one from Missouri - had been linked to sick dairy cows or poultry. [Read more.]( [More people want to come to Vermont for medical aid in dying than the system can handle]( Removing the residency requirement has brought an influx of out-of-state interest to Vermont's program. [Read more.]( [More people want to come to Vermont for medical aid in dying than the system can handle]( Removing the residency requirement has brought an influx of out-of-state interest to Vermont's program. [Read more.]( [Women who are blind play a critical role in identifying possible breast cancers]( Dr. Frank Hoffman was appalled by the sheer numbers of cases of early-stage breast cancer that were being missed. Then he had an idea: What if "we were to specially train others to do it." [Read more.]( [Women who are blind play a critical role in identifying possible breast cancers]( Dr. Frank Hoffman was appalled by the sheer numbers of cases of early-stage breast cancer that were being missed. Then he had an idea: What if "we were to specially train others to do it." [Read more.]( What We're Reading 📚 - Do You Have Healthy Brain Habits? ([The New York Times]( - Doctors Use Problematic Race-Based Algorithms to Guide Care Every Day. Why are They so Hard to Change? ([STAT]( - Compare the Candidates [Harris and Trump] on Health Care Policy ([KFF News]( Your Health [Yeast infections are miserable. And some over-the-counter treatments can backfire]( For some people, one-day topical treatments for yeast infections can cause their own irritation. And some doctors steer their patients away from the one-day options - which contain 12 times the medicine of the seven-day treatment. [Read more.]( [Yeast infections are miserable. And some over-the-counter treatments can backfire]( For some people, one-day topical treatments for yeast infections can cause their own irritation. And some doctors steer their patients away from the one-day options - which contain 12 times the medicine of the seven-day treatment. [Read more.]( 🧠💥 Did you know...💥🧠 ...air pollution is associated with a higher infertility risk in men, while noise pollution is associated with a higher risk of infertility in women? [The Guardian has more on the study]( out in the BMJ. 😎 Forward to a friend. They can sign up [here](. 🔎 Explore [WBUR's Field Guide]( stories, events and more. 📣 Give us your feedback: newsletters@wbur.org 📧 Get more WBUR stories sent to your inbox. [Check out all of our newsletter offerings.](   [Donate](   # # Want to change how you receive these emails? Stop getting this newsletter by [updating your preferences](.   I don't want to hear from WBUR anymore. Unsubscribe from all WBUR editorial newsletters [here](.   Interested in learning more about corporate sponsorship? [Click here](. Trustees of Boston University on behalf of WBUR, 890 Commonwealth Ave Boston, MA, 02215, US Copyright 2024 WBUR-FM, All rights reserved.