Based on extensive research into Contingency Management (CM), we have a good understanding of its effective delivery. The following outlines the considerations for the six main components.

Target Behaviors
Providers and patients should jointly determine specific behaviors to focus on, based on the research evidence and the patient’s preferences. Targeting abstinence has the strongest evidence. Other common targets include treatment attendance or adherence to medication (like methadone or buprenorphine). For CM to be effective, the target behaviors must be both objective and verifiable. This means that if the target behavior is abstaining from the targeted activity or substance, the behavior should be verified through a toxicology screen, rather than relying solely on the patient's report. Behaviors should be objective and verified to make certain that all patients are held to the same standard. Studies show that focusing on just one behavior or just one substance at a time works best. For example, studies that target abstinence from stimulant use have generally had larger effect sizes than studies that target abstinence from all substances.

Timing
It is recommended to give incentives immediately after the patient meets the target behavior. Delaying incentives makes CM less effective. This means that if the target behavior is abstinence, toxicology screens should be conducted right away and should have rapid results. Toxicology screens that are sent to labs are not an ideal fit for CM.

Frequency
CM incentives should be given at least once a week, ideally more often. Research suggests that providing opportunities for rewards more often makes CM more effective. When targeting abstinence, decisions about frequency should take into account how long the substance stays in the body. For instance, stimulants are only detected on toxicology screens for two to three days, so CM protocols targeting stimulant abstinence generally recommend administering screens at least twice per week.

Types of Incentives
There are two major types of CM: voucher or prize-based.

Voucher CM allows patients to earn vouchers for money or goods, or services, with a set amount that increases at regular intervals.

Prize-based CM protocols use an element of chance and allow patients to earn more and more chances to win a prize.

In both voucher and prize-based protocols, incentives can include intangible goods such as parking or front-of-the-line privileges, though tangible goods are generally considered best practice. Modern technology, such as apps, can also be used to monitor behaviors and provide rewards. The most effective type of reward is one that motivates the patient.

Size of Rewards
Rewards should generally be predictable, and their size should increase over time. Effective prize-based CM protocols generally enable patients to earn an expected amount of at least $400, whereas effective voucher-based protocols typically allow patients to earn at least $600. Studies show that higher maximum earnings lead to better results.

Reward Schedule
The size of the reward can stay the same, increase, or decrease over time. Research suggests that increasing rewards over time is most effective.