Comments on the Practical Use of Contingency Management

Disclaimer:  nothing in this post should be taken or held as clinical instruction, clinical supervision, or advisory concerning patient care. 

A colleague in the field asked me to make some comments on Recovery Review about the use of contingency management (CM) within clinical services for substance use disorders (SUDs).

This colleague expressed the concern to me that contingency management:

• is not sufficiently understood by those currently leading change within our field;
• but is usually funded (due to being well-known as an evidence-based practice);
• and its implementation may be aimed at merely helping to reduce use while its broader usefulness and various limitations are not well understood.  

I also inferred this colleague is concerned that CM may be added to SUD services toward reducing use while not being aimed at:

• improving the sustainability of positive treatment effects;
• the development of one’s own recovery capital; 
• moving toward wellbeing/quality of life;
• and incentivizing autonomy. 

The colleague said that they were asking me to comment on contingency management in SUD services based on my background in behaviorism and experience with implementation of CM.  

In this series I’ll discuss CM in SUD services by presenting 4 particular real examples I was involved in:

1. Adding prize tickets to increase group attendance in an outpatient program;

2. Innovating a “Start Now” outpatient group for those on a waiting list to enter a residential treatment program;

3. Providing a mobile device for live human coaching and clinical support of people with severe SUD who rely on public resources; and

4. Forming an IOP built specifically for those needing or already prescribed buprenorphine for opioid use disorder.

After each of these four examples I will anchor the reader in lessons learned related to CM.  

Hopefully by the end of this series the reader will come to the conclusion that the simple contingency management method of paying people with severe SUDs cash money to use less might not be a great way to implement CM in SUD services.

The next post in this series will describe an innovative prize ticket system we implemented to increase outpatient group attendance.