Substance use treatment that sees the whole person
When Lee returned to San Francisco after serving a 25-year prison term, he faced no shortage of hardships. Decades of working in the shipyards, playing football, and doing hard labor had done his body in, and he was in desperate need of a back operation. He couldn’t work, and had nowhere to live, so was staying in a shelter. He relied on drugs to manage his severe pain, but his substance use complicated his situation even further.
That’s when he met Roy Tidwell, a program coordinator at the San Francisco AIDS Foundation’s Positive Reinforcement Opportunity Project (PROP). PROP is a contingency management program, a method of substance use treatment that relies on providing small financial incentives to people who test non-reactive (negative) for stimulant drugs like crack or methamphetamine.
Several days a week, participants in the PROP program gather in a lounge at SFAF’s headquarters. There’s coffee, and snacks, and a question written on a white board to kickstart conversation. People share their stories, their struggles, make each other laugh, and at some point, step aside with a staff member to have a urine analysis done. If they test negative for drugs, they’ll earn a small financial incentive. With each subsequent negative test, that amount increases.
It’s not all about drugs and testing, however. At SFAF, PROP comes with vital wraparound services: trained staff can assist people struggling with substance use in getting housing, healthcare, and therapy.
That’s how Roy first earned Lee’s trust. He connected him with a therapist. He helped him find housing. He hooked up with medical care, and Lee finally got that long-awaited back surgery. Roy even identified funding to help Lee get an electric wheelchair. When he was ready to address his substance use issues, Lee started a 12-week contingency management program with PROP.
Decades of comprehensive research have shown contingency management to be incredibly effective, both in helping people achieve abstinence or guiding them to use drugs in a way that centers health and safety.
“We’re not paying people to use drugs or not use drugs,” Roy explained. “We’re supporting people in changing their relationship with drugs.”
The 12-week program requires participants to show up three days a week. A non-judgmental environment is key to ensuring people return. “If someone comes back with a reactive test, we don’t treat it like it’s a big deal,” Roy said. “We say ‘Tell me what happened,’ and listen. Then we’ll ask ‘what’s the next goal that you want to set for yourself? Do you want to go back to being abstinent? How you want to handle it?’”
This unconditional care is vital as people navigate their substance use. Lee remembers one particularly difficult moment during his recovery journey, when he called Roy for help. “I made a phone call and he came right over, picked me up, brought me right into the meeting, and helped me stand back up,” he said. “No matter how many times I would call Roy he would show up, no matter what.”
After months of work, Lee graduated from the program. This moment doesn’t occur without fanfare; every person who completes 12 weeks with PROP gets a certificate and a palm-sized silver star.
For Lee this is more than just symbolism. “It lets me know that I’m still here,” he says of the star. “I’ve gone through a lot of changes, from a misled young man, to an angry man, to now an elderly person. I’m not perfect, but all I have to do is just keep trying and just keep living. That’s what those stars mean to me.”
Program graduates can still come by SFAF; PROP hosts alumni gatherings for people to continue connecting with one another and providing support within a safe community. Lee attended those regularly, but at a certain point, it was time to say goodbye to the program.
Stepping away has been its own journey for Lee, one that requires some bravery. “I was so fixated on this building, and then they made me go outside and grow,” he said. “PROP taught me how to do real life. Everybody keeps telling me, ‘Man, you’re doing beautiful. Just hold on. Just keep going down the right path.’”
