Contingency Management

What is Contingency Management?

Contingency management is a type of therapy that provides rewards to clients for positive behavior changes while in treatment. By rewarding clients for positive outcomes, it increases the likelihood that the behavior will happen again. In the context of  substance use disorder (SUD) treatment, this can involve providing a reward (a gift card, cash, or other prize) for a positive behavior in line with treatment goals, such as producing a negative urine drug test result or attending a scheduled individual or group therapy session.

Decades of research has demonstrated that contingency management is one of the most effective treatments for SUD because it significantly improves treatment engagement, retention, and outcomes. It is particularly helpful for stimulant use disorders, which still do not have any FDA-approved medication treatments. Contingency management is included in  SAMHSA’s guide for the Treatment of Stimulant Use Disorders, and the U.S. Department of Veterans Affairs has incorporated it into their health services.

Read the factsheet.

Benefits of Contingency Management

Over thirty years of research has consistently demonstrated the positive impacts of contingency management, including:

• Reductions in drug use
• Increased treatment retention
• Effectiveness for diverse populations, including people with co-occurring medical and/or mental health conditions, people involved with the criminal legal system, and people experiencing homelessness

It is also easy to implement in a variety of treatment settings and works well in conjunction with other forms of treatment.

Barriers to Contingency Management

Despite the overwhelming evidence, contingency management is not widely used as part of addiction treatment. Some barriers include:

• Lack of provider knowledge and training on the approach
• Lack of insurance coverage for the approach
• Few federal or state research funds to implement pilot studies.

• Cost of acquiring rewards such as gift cards, hygiene kits, cash, etc.
• Stigma among providers

With adequate resources and support, these obstacles can be overcome.

Read the factsheet.