Contingency Management

Before implementing Contingency Management, programs must ensure that they have sufficient funding for key materials, such as toxicology screenings and incentives. Programs must also dedicate sufficient time to staff training.

Evidence for the intervention

Evidence supporting contingency management (CM) comes from more than ten systematic reviews and meta-analyses, drawn from over 100 randomized controlled trials. This evidence shows that CM helps patients with a range of different substance use disorders and is highly effective for patients with stimulant and opioid use disorders. For stimulant use disorders, CM is the most effective treatment available and is recommended as both a standalone treatment and an adjunctive treatment in combination with medication or other behavioral treatments. For opioid use disorders, CM is a highly effective adjunct to medication for opioid use disorder and is not recommended as a standalone treatment option. Based on its effectiveness as a standalone treatment for stimulant use disorder treatment and an adjunctive treatment for opioid use disorder, documented across multiple systematic reviews, CM earned our highest evidence rating.

Evidence-based Scale

The primary costs associated with implementing Contingency Management (CM) include the expenses of toxicology screens (when targeting abstinence) and the cost of incentives. In a meta-analysis of CM for substance use disorders, maximum incentive earnings ranged from $157 - $5,800, with patients earning incentives across 1 to 52 weeks of treatment. In general, prize-based CM protocols tend to cost approximately $400 per patient, whereas voucher-based CM protocols tend to cost approximately $600 per patient.

Other logistical considerations include the need to provide sufficient training and implementation support to providers. As elaborated in the implementation strategies section, programs often require training and ongoing support. Due to the numerous details associated with CM delivery, time should also be spent ensuring that the CM protocol aligns with the program workflow.