In clinics that adopt CM, training and supervision are paramount to ensure core aspects of CM are retained. Only about half of clinics providing CM arranged for in-house or off-site training (Olmstead, Abraham, Martino, https://rehabliving.net/ & Roman 2012). Clinician skill in administering CM impacts patient outcomes (Hartzler, Beadnell, & Donovan 2017; Petry et al., 2012a), and supervision can maintain fidelity over time (Petry et al., 2012a,b).

1. Do we proceed “business-as-usual,” continuing to promote the same tired approaches, or do we instead follow the science by allocating resources to expand access to proven, life-saving treatments that work?
2. The CM approach (also referred to as motivational incentives, the prize method, or the carrot-and-stick method) can be highly effective in treating substance use disorders.
3. Surging overdose deaths, coupled with consistently abysmal rates of medication adherence and treatment retention, make it clear that the time is now for contingency management for opioid use disorder (OUD).
4. By providing reinforcement contingent on attendance,attendance rates across a range of treatment settings can be substantiallyimproved,1-3thereby increasing exposure to effective care.
5. Contingency-management (CM) based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM models continues to grow.
6. The Office of National Drug Control Policy’s stated priorities include addressing policy barriers related to contingency management interventions, and exploring reimbursement for motivational incentives and digital treatment for addiction.

However, among youth not entirely abstinent from alcohol, those receiving CM reported fewer alcohol use days during the 36 weeks after the end of treatment than those not receiving CM. Among youth who also used cannabis at baseline, results showed similar benefits of CM on cannabis use days. Academic-industry partnerships are critical to building, testing, and scaling technology-enabled, reward-based solutions for OUD. Such collaborations could substantially advance addiction treatment systems by jointly bringing intuitive, science-backed solutions to market, which serve to improve uptake of contingency management and increase the availability of treatment slots by leveraging the efforts of program staff, particularly in underserved areas, where staff shortages are common. Although there is great potential for technology-enabled solutions to further support the prevention, treatment, and recovery of OUD by addressing practical barriers to adoption, OUD mobile apps often lack empirical evidence from well-designed studies supporting their use [63].

Contingency Management for the Treatment of Substance Use Disorders

Ending treatment needs to be paired with relapse prevention strategies to reduce the risk of relapse. If you or anyone you know is undergoing a severe health crisis, call a doctor or 911 immediately. Our addiction treatment specialists are here to assist you in verifying your insurance coverage.

Please also list any non-financial associations or interests (personal, professional, political, institutional, religious or other) that a reasonable reader would want to know about in relation to the submitted work. Regarding Sobriety 24/7, an example of system-wide CM approaches described above, the clarity and transparency of the contract and the immediacy and certainty of the consequence, even though a modest one, makes this approach a highly beneficial and cost-effective one for multiple DUI offenders. The overarching goal of CM is to consistently act in effective ways (i.e., to become empowered by values and personal goals) even when experiencing difficult or disruptive inner experiences.

Pros and Cons of Contingency Management Interventions

Over100,000 Americans died of a drug overdose in the past year with roughly 75% attributed to opioids [1], and the estimated annual opioid-related cost to U.S. society is upwards of $1.02 trillion [2,3]. At such a critical juncture, faced with a record number of annual overdose deaths, we have an opportunity to turn the tide. Do we proceed “business-as-usual,” continuing to promote the same tired approaches, or do we instead follow the science by allocating resources to expand access to proven, life-saving treatments that work? Surging overdose deaths, coupled with consistently abysmal rates of medication adherence and treatment retention, make it clear that the time is now for contingency management for opioid use disorder (OUD). Parents also earned incentives for session attendance, and compliance with the SMC (maximum earnings ~$270).

Efficacy of Contingency Management Examples

“Smart” debit cards allow card administrators (e.g. treatment program staff) to toggle specified blocking capabilities on/off to prevent cash withdrawals or purchases at identified high-risk vendors (e.g. bars, liquor stores, casinos). Both providers as well as patients in OUD treatment settings overwhelmingly prefer the use of “smart” pre-paid debit cards relative to giving patients actual cash, and view spending restrictions as an appropriate safeguard, particularly early on in one’s recovery [24]. Clinically, providers and patients alike may find it useful to collaboratively identify high-risk vendors or spending categories to block with clearly outlined expectations for the eventual withdrawal of all spending restrictions over time based on patient preference and response to treatment. With technology-enabled contingency management, patients are also incentivized to provide clinically-meaningful outcomes data using the app, which can then be reviewed by the provider in real-time using the dashboard.

It takes into account different variables, such as the target behavior, resources, the amount of clinical contact a provider has with their patients, and whether a behavior will be reinforced every time or only some of the time a behavior occurs. However, programs must work to find rewards that fit their budget while providing enough incentives. CM is also effective in treating people with co-occurring disorders.2 This is when someone is diagnosed with a SUD and a mental health disorder. In some centers, this therapy cannot be implemented due to insufficient resources, either monetarily or in terms of trained personnel.

Researchers began studying Contingency Management (CM) as an intervention for alcohol use disorder in the 1960s. Also during this time, other more involved treatment approaches capitalized on these operant conditioning principles present in CM, while also incorporating ways to enhance coping skills and sober quitting alcohol cold turkey social activities, such as the Community Reinforcement Approach (CRA). Contingency management is just one approach used in treatment and recovery from alcohol or other drug addictions. A quality treatment provider will employ a number of different evidence-based therapies, including Twelve Step Facilitation.

Peer-Based Recovery Support

In terms of this latter category, clients may decide upon three discrete activities each week that are related to their treatment goals. These may be attending a medical appointment if the goal is to improve health, going to the library with their child if the goal is to improve parenting or filling out a job application if the goal is to obtain employment. If clients successfully accomplished these activities and provided objective verification of their completion via receipts (Petry et al., 2001b), they received rewards. In one study at an HIV drop-in center, we found that providing reinforcement increased attendance at groups from an average of less than one patient per week to over seven per week and that reinforcing compliance with goal-related activities increased compliance rates from less than 30% to over 65% (Petry et al., 2001a). Similarly, Silverman et al. (2001) described a vocational training program in which substance abusers receive paid training opportunities contingent upon drug abstinence, and Milby et al. (2000) have a program that provides housing to homeless cocaine abusers that is contingent upon abstinence.