Psychiatrist Dr. Sally Satel, medical director of a methadone clinic, explains contingency management - a harm-reduction approach where clients receive small, escalating rewards (e.g., gift cards) for clean tests. She covers why this behavioural nudge works especially for stimulant addictions (where no gold-standard meds exist), typical program structures, cost/benefit logic, and how incentives can jump-start a virtuous cycle toward work, relationships, and stability. A nuanced, evidence-informed look at an approach that’s effective yet often misunderstood. Find out more on Substack and connect on X/Twitter.