Despite decades of research proving contingency management (CM) as one of the most effective treatments for substance use disorder, misconceptions persist. Here’s what the evidence actually shows.
Myth: Contingency management does not work.
The Facts:
A 2018 network meta-analysis of 50 randomized controlled trials with nearly 7,000 participants found that contingency management combined with community reinforcement was the only intervention significantly linked to higher abstinence rates at 12 weeks and at the end of treatment for cocaine and amphetamine addiction—making it the most effective and acceptable approach short- and long-term.
More recently, a 2025 study in the American Journal of Psychiatry analyzing the entire Veterans Health Administration database reported that veterans with stimulant use disorder who received contingency management had a 41% lower risk of death compared to those receiving standard care.
For opioid use disorder, a 2021 meta-analysis in JAMA Psychiatry of 74 randomized clinical trials and over 10,000 adults found contingency management significantly improved abstinence from opioids and other substances, as well as treatment attendance and medication adherence.
Perhaps most importantly, a 2021 meta-analysis on long-term outcomes showed participants receiving contingency management were 22% more likely to remain abstinent at follow-up (median 24 weeks after incentives ended) compared to those in other evidence-based therapies, including cognitive behavioral therapy.cial incentives to fight addiction are the right way to achieve sustained abstinence.
Myth: People will just use the money to buy drugs
The Facts:
Concerns about contingency management often stem from stigma, not evidence.
Research consistently shows that participants receiving contingency management maintain or even increase their internal motivation for change. A found the approach effective across diverse populations and settings, with no evidence that incentives lead to increased substance use or misuse of funds.
Similarly, a 2020 systematic review of 27 studies on methamphetamine use disorder reported that 20 of 21 studies showed positive abstinence outcomes, and researchers noted no systematic misuse of rewards.
Modern digital platforms, like CHESS Health’s Rewards Engine, add another layer of security with merchant-level restrictions that prevent cards from being used at locations like liquor stores or for uses like lottery tickets, though research suggests these safeguards address concerns that rarely occur in practice.
Myth: External rewards undermine internal motivation
The Facts:
Research directly contradicts the notion that external rewards weaken intrinsic motivation for recovery. The long-term outcomes meta-analysis found that benefits of contingency management persisted well after incentives ended, with participants maintaining outcomes as good or better than comparison groups six to nine months post-treatment. This sustained benefit would not occur if external rewards undermined internal motivation.
A 2018 network meta-analysis examining various psychosocial interventions found that contingency management showed benefits that persisted even after programs ended, suggesting the intervention helps establish lasting behavioral patterns. The neurological mechanism appears to involve reinforcing neural pathways during vulnerable early recovery periods, helping individuals build the internal capacity for sustained change. Studies comparing contingency management participants to control groups have found equal or greater indicators of internal motivation among those receiving incentives.
Myth: It only works in controlled research settings
The Facts:
Multiple large-scale implementations have demonstrated that contingency management translates effectively from research to community settings. The Department of Veterans Affairs implemented contingency management nationwide starting in 2011, with studies showing approximately 70% uptake within the first two years, increasing to 90% over time. This represents one of the most successful dissemination efforts for an evidence-based behavioral intervention.
CHESS Health has partnered with multiple organizations to implement contingency management programs with impressive real-world results.
- Grand Mental Health saw higher program completion rates after adoption.
- Cascadia Health reported reduced cravings, better sleep, improved overall health, and increased protective behaviors among patients.
- Sun River Health achieved a remarkable 98% treatment retention rate for patients receiving recovery incentives—compared to just 73–80% among those without incentives.
These successes span diverse populations in both rural and urban settings, proving that contingency management is feasible and effective across community contexts.
Myth: It’s too complicated to implement
The Facts:
While early contingency management programs faced implementation challenges, systematic reviews have documented successful strategies for addressing barriers to clinical adoption. The development of standardized protocols and digital delivery platforms has significantly reduced implementation complexity.
CHESS Health offers an industry-leading customizable platform for automating contingency management and streamlining processes for greater efficiency and simplicity.
Myth: We can’t afford it
The Facts:
Policy support for funding has expanded significantly. The Substance Abuse and Mental Health Services Administration (SAMHSA) increased the recommended cap on incentives from $75 to $750 per patient per year in 2025, reflecting growing recognition of the intervention’s value. Multiple states have secured Section 1115 Medicaid demonstration waivers to cover contingency management services. Organizations also access funding through State Opioid Response grants, Tribal Opioid Response funds, and opioid settlement allocations.
Myth: Contingency management isn’t allowed by regulations
The Facts:
Federal regulatory barriers to contingency management have been systematically addressed and clarified. In 2020, the HHS Office of Inspector General issued guidance addressing widespread misunderstandings about prior OIG guidance and emphasized that contingency management programs must be evaluated on a case-by-case basis rather than being categorically prohibited. In 2022, OIG issued Advisory Opinion 22-04, concluding that a digital contingency management program would not violate federal Anti-Kickback Statute or Beneficiary Inducement Prohibition, marking the first time OIG provided such approval for a nationally accessible contingency management program offering full-value monetary rewards.
