What is Contingency Management?

Contingency Management (CM) leverages the power of incentives for recovery and is the foundation of DynamiCare’s rewards-based approach.

CM is one of the most effective and evidence-based psychosocial treatments for substance use disorders. In over 100 randomized controlled trials and 9 meta-analyses (see footnote 1), CM significantly enhances outcomes.

Despite proven success, CM is used by less than 10% of U.S. treatment programs (see footnote 2). Practical barriers to adoption include lack of funds, the frequent drug testing required, lack of training for staff, and the difficulty of managing the rewards.

DynamiCare solves obstacles that have prevented CM’s adoption by using a fully automated, convenient platform that includes random substance tests, GPS treatment attendance tracking, and accountable monetary rewards.

Our goal is to make CM easy and accessible for researchers everywhere, and contribute to this critical and growing field.

Dr. Gastfriend, an addiction psychiatrist and Distinguished American Society of Addiction Medicine (ASAM) Fellow, has written a comprehensive guide on CM. Download Dr. Gastfriend’s guide below to learn how CM can provide the tools needed for organizations to assist their members in controlling addictive behaviors.

 Leading Research

How Many Studies Have There Been on Contingency Management?

1) How many randomized-controlled trials (RCTs) have been conducted and published on the efficacy of CM?
Answer: Over 100 RCTs have been conducted demonstrating the effectiveness of CM.
Prendergast et al 2006 found 47 trials of CM published between 1970 and 2002(all of which were RCTs except for 4 quasi-experimental studies).
Similarly, Dutra et al 2008 found 34 RCTs of CM published between 1988 and 2005.
Davis et al 2016 found 69 RCTs of CM published between 2009-2014.
Adding either the pre-2002 or pre-2005 count with the post-2009 count gives a total of at least 100 high quality RCTs on CM. The vast majority of these studies found positive effects for CM.

2) How many meta-analyses have been published on CM?
Answer: At least 9 meta-analyses have been published on CM. Here is a non-exhaustive list:

1. Griffith et al 2000, “Contingency management in outpatient methadone treatment: a meta-analysis.”

2. Lussier et al 2006, “A meta-analysis of voucher-based reinforcement therapy for substance use disorders.”

3. Dutra et al 2008. “A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorders.”

4. Petry et al 2012. “Financial reinforcers for improving medication adherence: findings from a meta-analysis.”

5. Benishek et al 2014. “Prize-based contingency management for the treatment of substance abusers: a meta-analysis.”

6. Ainscough et al 2017. “Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: A systematic review and meta-analysis.”

7. De Crescenzo et al 2018. “Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis.”

8. Getty et al 2019. “Mobile telephone‐delivered contingency management interventions promoting behaviour change in individuals with substance use disorders: a meta‐analysis.”

9. Ginley et al 2021. “Long-term efficacy of contingency management treatment based on objective indicators of abstinence from illicit substance use up to 1 year following treatment: A meta-analysis.”

All of these meta-analyses found positive effects for CM.

What Percentage of Addiction treatment programs use contingency management?

Answer: Less than 10% of U.S. addiction treatment programs use CM in routine clinical practice.

Herbeck et al 2008 studied the adoption of evidence-based practices in U.S. addiction treatment programs. Only 7% of treatment programs surveyed reported using CM (vouchers) frequently/always. One reason that adoption of CM has been poor in the U.S. addiction treatment system is that there is no billing code for it, and it is generally not reimbursed/covered by health insurance. The Veterans Administration is one system where CM has been widely adopted into routine clinical practice.

To see if your insurance, employer, or treatment program covers the cost of DynamiCare’s CM program, please see our coverage pathways.

 Interested in DynamiCare
for Your Research?

We’ve built a flexible tool to enable seamless CM research and we want to partner with you!

DynamiCare can streamline your study management, improve validity, enhance flexibility, increase data quality and resolution – all at lower cost than any other approach.

Questions?
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