Finland's capital Helsinki is launching a controversial trial offering gift cards to young people addicted to the stimulant 'peukku' who stay in treatment. The pilot program, set to begin this year, will reward participants with vouchers for supermarkets and other retailers as they progress through detoxification and rehabilitation. This approach, known as contingency management or incentive-based treatment, represents a significant shift in Finnish drug policy, moving from purely abstinence-based models to methods incorporating behavioral reinforcement.
Professor Solja Niemelä, an addiction medicine specialist at the University of Turku, has championed this method for decades. "I have been waiting 20 years for something like this," Niemelä said, criticizing Finland's slow adoption of evidence-based practices. "We have a wealth of international research showing this treatment is effective. Yet in Finland, this has hardly been done at all before now." Her comments highlight a persistent gap between global scientific consensus and local implementation within the Nordic welfare state.
A Professor's Two-Decade Advocacy
Professor Niemelä's frustration stems from watching proven interventions gather dust while addiction rates, particularly among youth, present an ongoing challenge. The Finnish National Advisory Board on Social Welfare and Health Care Ethics (Palveluvalikoimaneuvosto) approved incentive-based treatment years ago, but practical application remained minimal. Niemelä attributes this delay to a combination of attitudinal barriers, lack of knowledge among practitioners, and perennial claims of insufficient funding.
"Smartly integrating a reward system into broader psychosocial treatment increases commitment to care," Niemelä explained. "It also reduces substance use and increases rates of recovery. It is especially effective in the early stages of treatment." She emphasizes that the program is not a simple handout. It must be a structured system with clear protocols, functioning as one component within comprehensive psychosocial support. The cost-benefit argument is central to her advocacy; she states the treatment pays for itself quickly compared to other societal costs of untreated addiction, such as healthcare, crime, and lost productivity.
Helsinki and Turku Pilot New Frontiers
The Helsinki pilot specifically targets young users of 'peukku,' a street name for a stimulant drug, often methamphetamine or amphetamine. As a relatively new substance, specific scientific data on 'peukku' is limited, but studies on other stimulants, particularly from the United States, show strong results for contingency management. The Helsinki model will provide tangible, immediate rewards—like grocery store gift cards—for verified negative drug tests or consistent attendance at rehabilitation sessions.
This is not an isolated initiative. The Southwest Finland wellbeing services county (Varsinais-Suomen hyvinvointialue) is planning a similar scheme for under-25s, indicating a potential regional policy shift. The parallel planning in Turku suggests a growing recognition among public health officials that traditional methods require supplementation. The Finnish approach carefully frames the rewards as part of a medical treatment plan, avoiding any perception of endorsing drug use, a sensitive balance in the nation's public discourse.
The Science of Reinforcement in Addiction Care
Contingency management operates on established principles of behavioral psychology. It uses positive reinforcement to encourage desired behaviors—in this case, treatment adherence and drug-free urine samples. The immediacy of the reward is crucial, creating a direct, tangible link between the effort of staying clean and a positive outcome. This can be particularly powerful in early recovery, where the long-term benefits of sobriety feel distant compared to the immediate craving for the drug.
International meta-analyses, including those by the U.S. National Institute on Drug Abuse, consistently rank contingency management as one of the most effective interventions for stimulant use disorders. Its efficacy for opioids, alcohol, and nicotine is also well-documented. The treatment works by targeting the brain's reward system, which is fundamentally hijacked by addiction, and providing a healthier, alternative source of positive reinforcement. Critics sometimes argue it is unethical to "pay people to be sober," but proponents like Niemelä counter that it is a medically sound treatment that reduces overall harm and cost to society.
Navigating Ethical and Attitudinal Hurdles
The slow adoption in Finland points to deeper cultural and ethical debates within the Nordic model. Finland's drug policy has historically emphasized prevention, abstinence, and social responsibility. Introducing a system of material rewards challenges a purist view of recovery that values intrinsic motivation above all. There is a concern that incentives might be seen as commodifying health or undermining personal responsibility.
Professor Niemelä directly confronts these attitudinal problems. The belief that there isn't enough money is, in her view, a false economy when considering the high societal cost of untreated addiction. The pilot programs in Helsinki and Turku are thus not just clinical trials but also social experiments. They test whether Finnish public opinion and political will can align with a pragmatic, evidence-based approach that may seem unconventional locally but is mainstream in international addiction science.
A Potential Turning Point for Finnish Drug Policy
The launch of these pilots could mark a turning point. If successful, they could pave the way for a broader integration of contingency management into Finland's national health service. Success would be measured not just by reduced drug use among participants, but by increased retention in treatment programs—a major hurdle in addiction care everywhere. The data collected will be vital for convincing skeptics and securing future funding.
This move also reflects a gradual European trend toward harm reduction and evidence-based practice, even in countries with traditionally restrictive policies. Finland is observing developments in other Nordic nations and the EU. The Finnish model, with its strong emphasis on integration within the state-funded welfare system, could offer a unique blueprint for combining social support with behavioral incentives.
Professor Niemelä's 20-year wait may finally be ending. The Helsinki and Turku initiatives represent a cautious but definitive step toward aligning Finnish practice with global evidence. The coming years will show whether gift cards can become a standard tool in Finland's fight against youth drug addiction, or if attitudinal and budgetary barriers will again slow progress. The outcome will reveal much about Finland's capacity to innovate within its own esteemed welfare framework and adopt solutions that work, even when they challenge tradition.