Accountable incentives for opioid recovery in Gary, Indiana

Gary, Indiana is one of the hardest-hit communities in the Midwest, facing severe opioid-related harm, low life expectancy, and the civic challenge of making crisis-response funding practical, dignified, and accountable.

The programme focused on contingency management, a treatment-support model that provides quick rewards in response to measurable recovery behaviour. Research on contingency management has shown materially higher treatment completion rates than standard care groups, but incentive delivery can be hard to manage when patients are unbanked, privacy matters, and taxpayer-backed funding needs a clear audit trail.

The wider U.S. context made the need urgent. In 2020, opioids were implicated in 75% of 91,799 drug overdose deaths, and overdose deaths rose sharply from 2019 to 2020. More than 932,000 Americans have died from drug overdoses since 1999.

Against that backdrop, Gary was not an abstract pilot site. It was a city where recovery support, public funding, local trust, and practical delivery all had to meet in one programme. The challenge was to make incentives fast enough to reinforce recovery behaviour while keeping the flow of funds accountable.

Unbox supplied FaithWorks with the FaithWorks Wallet, a digital wallet model for distributing recovery incentives tied to SAMHSA funding. The project applied traceability to USD 500,000 of funding, with patients receiving Ucoin tokens inside a closed-loop system rather than ordinary cash.

The wallet was designed to confirm proof-of-presence at recovery sessions. Patients could validate attendance by scanning a one-time data matrix produced by the clinic, with geofencing helping ensure the check-in happened at the right location.

That proof-of-presence function was central to the accountability model. Contingency management depends on a measurable behaviour; the programme therefore needed a way to connect the reward to attendance without asking clinics or participants to rely on slow manual reconciliation.

The closed-loop token model also helped keep incentives aligned with programme intent. Rather than distributing cash without visibility, the system could support defined local use while still preserving the recipient's ability to transact with dignity.

The important shift was not that the programme used wallets. It was that incentive distribution became part of an evidence layer. The system could show whether incentives were earned, where they were used, and how funding moved through the intended local ecosystem.

That evidence mattered for public-sector accountability. Recovery incentives need to reach people quickly, but programme owners also need to understand engagement, protect against misuse, and report back without adding stigma or administrative burden for patients.

For SAMHSA-funded work, the evidence question is not optional. Public funding needs to show not just that money was allocated, but whether it supported the intended intervention and whether the intervention created a stronger basis for recovery engagement.

Unbox helped make that possible by connecting attendance, incentive release, and transaction activity into a more coherent picture. Programme teams could understand engagement as it happened rather than reconstructing it after the fact from disconnected records.

The model emphasised financial inclusion for people without a fixed address or ordinary banking access, as well as self-sovereign identity management to protect privacy while preserving transaction traceability.

Because tokens were programmed for use inside a local closed loop, the intervention also aimed to keep value moving through the community it was meant to support. In Gary, the operational value was a more accountable way to turn public funding into measurable recovery participation and local economic activity.

This balance matters because recovery programmes have to be humane as well as measurable. A system that proves everything by creating stigma or exposing sensitive information would fail the people it is meant to support.

The Gary deployment therefore sits close to the current Unbox story: accountable funding does not need to mean colder funding. Done well, the evidence layer can make public money easier to trust while keeping the participant experience simple, private, and respectful.