Contingency Management

Contingency management is a type of therapy that provides rewards (also known as motivational incentives) to clients for positive behavior changes while in treatment. The therapy is based in the principles of operant conditioning – a reward is given for a behavior so that it will increase the likelihood that a 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 psychosocial treatments for SUD because it significantly improves treatment engagement, retention, and outcomes. It is particularly helpful for stimulant use disorders, which still do not yet 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.

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 employed in substance use treatment services. 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 motivational incentives such as gift cards, hygiene kits, cash, etc.
  • Stigma among providers and a misperception that contingency management pays patients to engage in proactive behaviors

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

How DPA is Working to Expand Contingency Management

The Drug Policy Alliance (DPA) is pushing for the widespread adoption of evidence-based interventions into SUD treatment, including contingency management. This is especially important for treatment of stimulant use disorders, for which no FDA-approved medications currently exist.

We are committed to challenging the stigma surrounding contingency management and advocating for the policies and resources that will increase access to this highly effective form of SUD treatment.

DPA is supporting efforts like California Senate Bill 110 which will make provision of contingency management reimbursable under the state’s Medicaid program. Making contingency management more financially attractive and sustainable are key to widespread adoption.

Drug Treatment