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) treatment outcomes. CM can improve medication adherence, and treatment retention and help people abstain from many addictive substances, even methamphetamine. Still, some myths remain.

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

CM is an evidence-based treatment based on established behavioral science or operant conditioning principles. Contingency Management is about rewarding desirable behavior to motivate people to build positive habits that stick.

Benefits of CM for SUD:

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

If CM works, why does the myth exist?

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

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

• CM 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, combined with Cognitive Behavioral Therapy (CBT) or community reinforcement, was highly effective compared to TAU (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 like 12-step meetings.

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

In reality:

• The use of CM has been identified as part of the Federal Government’s first-year drug policy.
• The National Council for Mental Wellbeing endorses CM for SUD.
  • In a press release, the 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 CM for SUD 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 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 CM program with CHESS Health.