Contingency Management for Substance Use Disorders: Myths vs Facts

Contingency management (CM) can be an impactful approach to address SUD and addiction. It is an evidence-based therapy that positively impacts substance use disorder (SUD) and addiction treatment outcomes. CM can improve medication adherence, treatment retention, and help people abstain from many addictive substances, including opioids, methamphetamine, and alcohol. Still, some myths remain.

Myth: Contingency management does not work.
Fact: The science is in. Contingency management is effective.

Contingency management is an effective, evidence-based treatment rooted in the established behavioral science of operant conditioning principles. Contingency management rewards desirable behavior to motivate people to build positive habits that stick.

Benefits of contingency management for substance use disorder:

• Improved treatment retention
• Higher medication adherence rates
• Desirable results regardless of a patient’s background, pre-existing conditions, or other challenges
• Easily applied in combination with other treatments

If contingency management works, why does the myth exist?

Despite its success, some clinicians and even the general public maintain suspicion regarding CM for SUD. The main concern is whether financial incentives to fight addiction are the right way to achieve sustained abstinence. 

Fortunately, extensive research shows how effective CM is for SUD, even in the long term:

• Contingency management reduced continued methamphetamine use.
• Cocaine abstinence increased when CM incentives were provided for cocaine-free urinalysis during treatment and one-year follow-up.
• It is the most effective way to treat stimulant use disorder.
• CM helped reinforce medication compliance and treatment retention for people with alcohol use disorder.
• A large meta-analysis based on 50 studies found that CM alone, or combined with Cognitive Behavioral Therapy (CBT) or community reinforcement, was highly effective compared to treatment as usual. These superior results were demonstrated at 12 weeks of therapy, the end of treatment — and even sustained in the long run. These findings are significant since long-term abstinence is ideal.  
• No data suggests CM-based incentives adversely affect patient participation in other interventions such as 12-step meetings.

Myth: Contingency management is not allowed as per regulations.
Fact: Experts continue to make progress on clarifying what is allowable for contingency management.

In reality:

• The use of CM has been identified as part of the Federal Government’s first-year drug policy.
• A 2023 report by the U.S. Department of Health and Human Services recommends expanding access to high quality contingency management services for the treatment of substance use disorders. In the list of resources cited in the recommendation, multiple studies showed the positive behavioral benefits of contingency management programs.
• The National Council for Mental Wellbeing endorses contingency management for substance use disorders.
  • In a press release, President and CEO Chuck Ingoglia stated, “…With no FDA-approved medication for methamphetamine or cocaine use disorder, organizations that provide substance use treatment need to be able to adopt contingency management, which represents the most effective evidence-based approach available….”
  • The council noted that contingency management is an effective recovery tool in more than 100 randomized controlled trials, doubling abstinence rates for opioids, alcohol, tobacco, and nicotine, as well as stimulant addiction, for which there are no medications approved by the FDA to use in treatment.

Want to learn more about what is allowable under current guidance?  Watch our on-demand webinar.

Myth: Implementing CM programs is very difficult.
Fact: Platforms explicitly designed to administer contingency management for substance use disorders are effective, user-friendly, and offer data-driven insights.

Until recently, there is no doubt that voucher-based incentive programs were difficult to implement, manage, and administer. There were many inefficiencies in the process. CM managers did not have a bird’s eye view or details of budget allocations, incentive deployment, and analytics related to effectiveness across the entire treatment program.

If you cannot track and measure it, how do you know it works?

CHESS Health can help. 

With the Rewards module within our eRecovery platform, you get a hassle-free rewards program customized to your needs. Now, you can:

• Track patient enrollment
• Manage one-time rewards or extended rewards
• Set up dollar limits and criteria for incentives
• Choose between debit cards or digital gift cards
• Track each patient’s progress through their continuum of care
• Gain data-driven insights on what’s working and what can be improved

With the CHESS Health Rewards module, you can implement a CM program from our Connections app or as a stand-alone module.

The best way to manage addiction and substance use disorder is through an integrated approach that includes screening, intervention, and treatment. Learn more about how you can implement your cost-effective CM program with CHESS Health.