Office of Primary Care and Area Health Education Centers (AHEC) Program

Addiction expert Richard Rawson, Ph.D., professor of psychiatry

(MARCH 15, 2023) Renowned addiction expert Richard Rawson, Ph.D., professor of psychiatry, consulted with program coordinators Tom Dalton and Jess Kirby as they were setting up their unorthodox substance use treatment program run by Burlington-based nonprofit Vermonters for Criminal Justice Reform, according to an article in Seven Days.

The program is based on an approach known as contingency management, which helps people overcome unwanted behaviors by offering small rewards, usually money. Incentive-based treatment programs usually only reward negative drug tests; however, the Burlington experiment pays participants even if they test positive for the target drug, fentanyl. All participants have to do is show up to the nonprofit’s downtown offices once a week. The protocol, believed to be the most tolerant in the nation, is an attempt to reach people who aren’t ready to stop using but who could benefit from weekly check-ins with counselors. Such connections could one day help steer them into recovery.

Research into contingency management has always held up abstinence as the only acceptable outcome. “There’s not really much in the literature for what to do when you’ve got a population where that’s not going to be realistic,” Rawson says. That’s a scary thought in the age of fentanyl. “In the old days, we used to talk about people hitting bottom. Now, people don’t hit bottom — they die.”

Diverting from the traditional contingency management guidelines in some key ways seemed necessary to Dalton and Kirby’s fundamental goal: keeping people alive. And their program’s enrollment success is gaining attention: “I’m working with a bunch of different pilots around the country,” Rawson says. “None of them have recruited as fast.”