Contingency Management: An Effective Treatment for Addiction
What is Contingency Management and How Effective Is It?
Contingency Management (CM), a behavioral intervention that provides reinforcements and rewards for taking specific positive actions, is among the most effective and powerful tools available to keep people with substance use disorder (SUD) engaged in treatment and adhering to a recovery plan. These rewards are so important in the battle against SUD that a 2023 report released by the U.S. Department of Health and Human Services makes detailed recommendations that providers consider implementing an established, evidence-based CM protocol to benefit their clients.
More than three decades of research support using CM for treating SUD, whether used as a standalone practice or in conjunction with other evidence-based treatments and recovery support services. Studies show CM produces higher abstinence rates during treatment, a higher likelihood of remaining in treatment, and a higher ability to maintain abstinence over time across diverse populations. It also works well alongside a variety of treatment options to increase their effectiveness and positive behavioral outcomes.
The impressive results have led to more opportunities for funding of CM programs from organizations such as the Substance Abuse and Mental Health Services Administration’s State Opioid Response (SOR) and Tribal Opioid Response (TOR) Grants, the Health Resources and Services Administration’s Rural Communities Opioid Response Program’s Psychostimulant Support Program, and the Centers for Medicare & Medicaid Services (CMS). CM is part of the Federal Government’s first-year drug policy, and the National Council for Mental Wellbeing endorses the practice for SUD.
The Science Behind Contingency Management
Research reveals that many individuals struggle with SUD because using drugs repeatedly over time hijacks and disrupts the brain circuitry. The positive feelings, pleasure, and pain relief that people with SUD experience after using drugs are reinforced by the brain’s reward center.
As a person continues to use drugs, the brain becomes more fixated on the cues that trigger use, yet less sensitive to the reward response and essentially unable to access the brain’s reward center without substance use. These individuals also become conditioned to immediate rewards, more susceptible to stress, and less likely to be able to self-regulate and make good decisions.
Effective CM solutions can compete with and push aside the reinforcing boost from substance use, helping individuals with SUD repair their brain circuitry to accept rewards from non-substance sources. It helps them reconnect with their ability to make choices that are in the best interest of their long-term health, and it gives them a needed break from the cycle of substance use, which allows for brain recovery.
Core Uses for Contingency Management
Research indicates that Contingency Management interventions are exceptionally effective in treating stimulant use disorder and other conditions without FDA-approved medications. Notably, CM is twice as effective as standalone Cognitive Behavioral Therapy (CBT) and counseling. Even more compelling, when combined with these approaches, CM significantly boosts overall program efficacy.
In some cases, CM can be a standalone solution, and in others, the protocol combines well with additional therapies to increase their effectiveness. Here are some common use cases where CM has demonstrated notable success:
- Stimulant Use Disorder: CM has shown high effectiveness in treating disorders related to stimulants, such as cocaine and methamphetamine use.
- Opioid use disorder: CM, used in conjunction with Medications for Opioid Use Disorder (MOUD), has been shown to improve MOUD adherence and end-of-medication abstinence
- Cannabis use disorder: CM, with CBT or other therapies, can help reduce the use and severity of the disorder
- Alcohol use disorder: CM is effective in reducing frequency and amounts of consumption and increases abstinence
- Tobacco use disorder: CM helps with smoking cessation
CM programs for addiction treatment can be designed in various ways, but those that award points or vouchers that translate into cash equivalents are among the most popular.
Some clinicians have expressed concerns about the ethics of CM and whether it makes individuals in recovery dependent on the rewards or less likely to access their own internal motivation. The depth of research around CM that draws positive conclusions, however, has proven that many of these concerns are more myth than fact.
What to Look for in a Contingency Management Platform
Health and Human Services (HHS) suggests that states, agencies, and providers consider digital technologies to deliver CM programs. Evidence-based digital options, like CHESS Health’s Contingency Management solution, provide the optimal protocols HHS suggests, and with 90% of Americans owning a smartphone, digital CM solutions are readily available to most of the population.
Digital solutions also remove some of the barriers to successful implementation of CM programs. Since the solutions are technology-based, once set up with the appropriate incentives and at the desired frequency, rewards are delivered immediately after a required action or behavior is completed.
Rewards can be automatically loaded onto digital gift cards or debit cards, avoiding the need to deal with cash. There’s no need for additional staff training to manage the program. Digital delivery enables secure and tracked transactions and can provide comprehensive reporting on fund utilization, which is crucial from a fidelity standpoint. This level of transparency allows providers to effectively measure the impact of behavior change, ensuring accountability and maximizing the effectiveness of their programs.
When evaluating digital options, providers and organizations should look for functional tools that are easy to use and onboard for their teams and clients. Digital technologies with high data security, like HITRUST Certification, should be sought, as well as numerous positive references to ensure the best results for providers and clients.
Key Considerations When Assessing a CM Platform
Funding Sources for Contingency Management Programs
Organizations interested in implementing contingency management programs for substance use disorder (SUD) can explore multiple options for funding, including several U.S. Department of Health and Human Services grant programs. Funding options include:
- Medicaid Section 1115 Waivers
- Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG)
- State Opioid Response (SOR) Grants
- Tribal Opioid Response (TOR) Grants
- RCORP Psychostimulant Support Program
- Opioid Settlement Funding
- Title IV-E Prevention Service Program Funds
- Private/ self-funded
CHESS Health offers the industry’s leading customizable rewards engine for the automated delivery of contingency management.
