With well over $400 in stimulant use disorder treatment vouchers, a 39-year-old Brunswick resident bought his son an abundance of toys at Walmart last Christmas.

“I loved seeing his eyes light up,” he said, asking to only be identified as Josh. “Being able to enjoy him again is very special.”

An image shows the reward payout process in a software that doles out incentives for negative urine drug test. The method is used in a stimulant use disorder treatment program in Brunswick. Courtesy of MaineHealth Mid Coast Hospital

Josh was one of the 20 clients at MaineHealth Mid Coast Hospital’s stimulant use disorder treatment program — the first-of-a-kind in the state — which launched in 2024. He credits the program, which hands out vouchers in exchange for negative drug screening results, in helping him get back on track. Other data from the program suggests that an incentive method paired with the team working in the program produces positive results when treating stimulant use.

The program, housed in what was formerly known as the Mid Coast Hospital Addiction Resource Center, aims to curb abuse of stimulants, such as amphetamines or cocaine. The program was modeled off of similar initiatives in California that use a method called contingency management — a treatment path that uses positive reinforcement.

“Even before this was an available treatment option, individuals with stimulant use disorder were still referred for substance use disorder treatment,” said the program’s clinical director, Christine Wyman. “It’s just there was not an evidence-based option to successfully treat them with. Now we’re able to do that.”

As the treatment program in Brunswick continues to operate, Wyman noted that the “guiding light” for it is to ensure American communities are at their healthiest — a status vital in potentially preventing substance use in future generations.

When the program launched in June 2024, it set a goal to treat about 30 people based on the available funding for each client.

Not long after the launch, Wyman said it partnered with the MaineHealth Comprehensive Addiction Medicine, which has a location in Portland, allowing the program to continue for the foreseeable future. On top of this, with the amount of funding clients are earning in the program, Wyman said it is possible to treat more people.

It felt ‘like home’

“I was self-medicating and just trying to make myself feel better, in a lot of different ways,” Josh said, recalling when he first entered the treatment program last July. “And it just spiraled out of control — not that doing drugs is any kind of control, you can’t really just go with it. And I went down that rabbit hole and I needed help to get out of it.”

While he described the program as “intimidating” at first, he knew that, ultimately, he was ready to be done with this part of his life. The crew that works with clients in the program had a welcoming presence.

“It got easier and easier as I went through, just because I felt more and more connected to everybody around here,” he said, noting that workers greeted him by name, never spoke down to him and stood behind him the entire way. He said that the program felt “like home.”

“I get emotional thinking about it, honestly. Just being where I was and where I am now, it’s amazing,” he said.

Josh completed the program on Dec. 16, 2024, and he credits his success to the supportive staff. While the financial incentives were helpful, it was really the people who made a difference, he said. He said that he hasn’t used since completing the program.

“Sometimes it crosses my mind, but I always just think back, like, ‘It’s not always easy, it’s never going to be easy,’ and I don’t want to go back to that place,” he said. “I could probably pick up the phone and call one of these workers here and definitely get through it that way. I feel that comfortable with everybody here. I honestly miss them.”

Josh said everybody struggling with stimulant use could benefit in some way from the program. Regardless, you have to be ready to give it up, he said, though he added that there will be “bumps and potholes and everything along the way.”

“I needed somebody to hold my hand and carry me a little ways and, you know, they did it,” Josh said. “They helped me do this. It’s a group effort, and it’s just an amazing place.”

Results

As of Feb. 2, the program has served individuals from 10 different municipalities in Maine. Wyman noted that many participants are also dealing with another substance use disorder, such as alcohol addiction.

The current attendance rate for clients in the program is 77% — a slight dip from the 83% attendance rate Wyman reported late January. She said that 66% of the urine drug screenings in the program are negative for stimulants, noting that this figure was higher before the holiday season. Of those who attend on testing days, negative urine drug screens average 85.5%.

Wyman said the rate at which they consider a test negative depends on two factors: an actual negative test result and whether the client showed up in the first place to give urine. If someone misses a drug screening, Wyman said that counts as a positive test.

She was unsure if a decrease in negative test results were tied to the season since the clinic has not previously operated during the holidays. She did note, however, that another clinic in Portland that offers a contingency management program observed similar data.

“I don’t think that we’re able to draw any conclusions from it, but it is an interesting observation,” Wyman said.

The program also reduces the rate of testing from twice a week to once a week after the first 12 weeks of participating. This means that instead of coming every Monday and Thursday, as is typical for the start of the program, a client will only test once on Monday for the remainder of the program.

Wyman said that she was unsure if a decrease in testing frequency could have an impact on negative test rates — there simply is not enough information yet.

Driving factors

By late January, clients had earned a combined total of $2,815 in incentives, Wyman said. No one has hit the $599 cap, which is the max amount an individual can earn in the program.

“Although $599 being allocated for an incentive feels high, when you consider (that) we’re able to reduce one emergency room visit, that has paid for it,” Wyman said. “When we consider the amount of money we spend on other treatments, this is still less.”

For instance, the average cost of one emergency room visit is $570, she said. For 24 weeks of Suboxone — a medicine used to treat opioid dependence — the cost, even with a GoodRX card discount, can be $1,000.

The incentive increases over time if the client does well, Wyman said. The reward temporarily decreases if the client produces a positive drug screen.

When a client earns a reward, Wyman said they receive a voucher either electronically or on paper to use for certain types of goods. For instance, the voucher cannot be exchanged for cash or used on alcohol, drugs, tobacco or cannabis, she said.

While the financial incentive is convenient, Wyman said there is a combination of benefits that keep clients in the program. While the incentives draw people in, she believes that good relationships with staff and having negative drug test results make clients stay in the program.

“And the reason why I think it’s such as combination for people continuing to come back is we have had individuals who keep coming and keep producing a positive urine drug screen, don’t get an incentive, and they keep coming back,” she said. “So, I really think there’s something about the relationship, along with the intended intervention that keeps people engaged.”

Josh added that stimulants are often overlooked as a drug, arguing that the program helps address an issue that goes undertreated in substance abuse intervention practices.

“I mean so many people need somebody to pick them up,” he said. “… This program really saves lives, I bet. I guarantee it will.”

For those struggling with addiction, the MaineHealth program can be reached at 373-6950 or toll free at 800-244-3805.

More information about substance use treatment programs can be found at mainehealth.org.