Contingency Management for Substance Use Disorders

Overseen By Mary Lonergan-Cullum, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Minnesota

Must be taking: Buprenorphine-naloxone

Must not be taking: Amphetamines

Disqualifiers: Dementia, Development disabilities, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 6

Duration: 3 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines the use of contingency management, a method where participants earn rewards for meeting specific goals, to treat opioid use disorder. The researchers aim to determine if this approach is effective in a primary care setting, particularly for individuals also facing stimulant use disorder. Participants receive monetary incentives for attending addiction treatment appointments and remaining substance-free. This trial may suit those who recently began taking medications like buprenorphine-naloxone (a treatment for opioid dependency) and are receiving care at the Broadway Family Medicine clinic. As an unphased trial, it offers a unique opportunity to explore innovative treatment strategies in a real-world setting.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you must have an active prescription for buprenorphine-naloxone (Suboxone) to participate.

What prior data suggests that contingency management is safe for treating substance use disorders?

Research has shown that contingency management (CM) is generally safe for people with substance use disorders. Studies have found that patients tolerate CM well, with no major negative effects reported. This treatment involves giving rewards, often money, to patients for reaching specific goals like attending appointments or staying drug-free.

CM has been successfully used in various settings, particularly for stimulant and opioid use disorders. It has a good safety record and helps people adhere to their treatment and improve their outcomes. As a behavioral approach focused on motivation, it doesn't use medications, which reduces the risk of side effects.

For those considering joining a trial that uses CM, past research suggests it is a safe method. However, always consult a healthcare provider about any concerns. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Contingency Management (CM) approach for treating substance use disorders because it offers a unique strategy compared to traditional methods like counseling or medication-assisted therapies. CM stands out by using positive reinforcement, such as rewards for attending appointments or maintaining abstinence, which can enhance motivation and adherence to treatment. This method directly incentivizes healthier behaviors, potentially leading to better engagement and outcomes than conventional treatments. The trial's focus on both attendance and abstinence CM techniques allows researchers to explore how these specific incentives can further improve recovery rates and long-term success.

What evidence suggests that this trial's treatments could be effective for substance use disorders?

Research has shown that contingency management (CM), studied in this trial, effectively treats substance use disorders. Participants may be assigned to different CM programs. Studies have found that CM reduces positive drug tests and increases participation in treatment programs. CM offers rewards, such as money, for attending medical appointments and staying drug-free. This method has succeeded in many settings, especially for individuals with opioid use disorders. Evidence consistently supports CM as a valuable tool for improving treatment outcomes in substance abuse. ^{6 7 8 9 10}

Who Is on the Research Team?

Robert Levy, MD

Principal Investigator

University of Minnesota

Are You a Good Fit for This Trial?

This trial is for adults over 18 with Opioid Use Disorder and/or Stimulant Use Disorder who recently started opioid addiction treatment at Broadway Family Medicine. They must be prescribed buprenorphine-naloxone (Suboxone). Those with dementia, developmental disabilities, or low cognitive function, or those on amphetamines can't join the abstinence-based part but may join the attendance-only part.

Inclusion Criteria

I am currently prescribed Suboxone.

Recently initiated medications for opioid use disorder (MOUDs) at Broadway Family Medicine (BFM), within 2 weeks of recruitment

Diagnosis of Opioid Use Disorder and/or Stimulant Use Disorder

Exclusion Criteria

Prescription for an amphetamine would exclude patients from the abstinence-based CM, but they could participate in the attendance-only CM

Dementia, development disabilities, or cognitive functioning that is too low to participate in study measures, as determined by chart review and consultation with overseeing physician.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive contingency management (CM) intervention, earning incentives for attending appointments and abstaining from substances

3 months

Regular follow-up appointments as per treatment plan

Follow-up

Participants are monitored for safety and effectiveness after treatment

9 months

Follow-up visits at 6 and 12 months

What Are the Treatments Tested in This Trial?

Interventions

• Contingency Management

Trial Overview The study tests Contingency Management (CM) in a primary care setting. CM rewards patients financially for attending addiction medicine appointments and staying substance-free. The goal is to see if this approach helps people stick with their outpatient treatment programs better.

How Is the Trial Designed?

Group I: Attendance-only CM Experimental Treatment 1 Intervention

Patients in this arm complete an appointments with his or her primary care provider (PCP) or member of the PCP's microteam . These appointments must be initiated by the PCP/microteam in accordance with the patient's treatment plan for regular follow-up appointments.

Group II: Attendance + abstinence CM Experimental Treatment 1 Intervention

Patients who test stimulant-positive during the initial urine drug screen (UDS) at their intake visit will be invited to additionally enroll in the abstinence CM schedule. All of the attendance-only CM rules described previously will apply to patients in the attendance + abstinence program.

Group III: Treatment as usual (TAU) Active Control 1 Intervention

These patients will not be assigned to the CM programs, but will be invited to complete study measures at the same time points: baseline, 3-months, 6-months, and 12-months.

Contingency Management is already approved in United States, European Union for the following indications:

Approved in United States as Contingency Management for:

• Substance Use Disorders
• Stimulant Use Disorder
• Methamphetamine Use Disorder

Approved in European Union as Contingency Management for:

• Substance Use Disorders
• Addiction Treatment

Who Is Running the Clinical Trial?

University of Minnesota

Lead Sponsor

Trials

1,459

Recruited

1,623,000+

Published Research Related to This Trial

A systematic review of 12 randomized controlled trials involving 1654 adults found that adding cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET) to contingency management (CM) did not improve rates of abstinence from substance use at the end of treatment or during follow-up.

The analysis showed no significant benefits in secondary outcomes, such as self-reported days of substance use, indicating that CM alone is as effective as when combined with these psychotherapeutic interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis. Sheridan Rains, L., Steare, T., Mason, O., et al.[2021]

Contingency management (CM) is an effective psychosocial treatment for substance use disorders that uses tangible rewards to reinforce drug-negative behaviors, showing strong efficacy based on behavioral analysis principles.

CM not only provides external rewards but may also enhance a patient's intrinsic motivation to change their substance use behavior, suggesting broader applications for this intervention beyond substance use disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivation and Contingency Management Treatments for Substance Use Disorders. Walter, KN., Petry, NM.[2016]

Contingency management procedures have been shown to effectively treat substance use disorders by providing rewards, like vouchers, for drug abstinence, particularly in psychosocial and methadone maintenance settings.

Recent adaptations of these procedures include using lower-cost reinforcers and expanding their application to improve treatment attendance, adherence to goals, and medication compliance, highlighting the versatility of this approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management for treatment of substance abuse. Stitzer, M., Petry, N.[2019]

In a study involving 142 outpatients with cocaine or heroin dependence, both voucher and prize-based contingency management (CM) interventions led to longer treatment retention and greater durations of confirmed abstinence compared to standard treatment.

While there were no significant differences in abstinence rates at 6- and 9-month follow-ups, the duration of abstinence achieved during treatment was the strongest predictor of continued abstinence after treatment ended.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vouchers versus prizes: contingency management treatment of substance abusers in community settings. Petry, NM., Alessi, SM., Marx, J., et al.[2016]

In a study involving 74 cocaine-dependent methadone outpatients over 12 weeks, both voucher and prize-based contingency management (CM) interventions led to longer durations of abstinence compared to standard treatment.

The study found no significant differences in outcomes between the voucher and prize systems, indicating that both methods are effective in promoting abstinence during treatment, which is linked to better long-term recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. Petry, NM., Alessi, SM., Hanson, T., et al.[2021]

A survey of 214 substance use treatment providers revealed that while many clinics are using reward programs, they often do not follow effective practices recommended by research, such as providing higher reward amounts or immediate reinforcement.

Providers with more extensive training in contingency management (CM) were more likely to implement effective strategies, suggesting that better training could improve the quality of reward-based interventions in real-world settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining implementation of contingency management in real-world settings. Rash, CJ., Alessi, SM., Zajac, K.[2021]

The study involved 103 outpatients with substance abuse issues and found that prize-based contingency management (CM) significantly increased the longest duration of sustained abstinence (LDA) compared to standard treatment, indicating its effectiveness in promoting recovery.

While CM did not lead to a significant difference in the number of weeks retained in treatment, participants in the CM condition reported lower rates of substance use at the 9-month follow-up, suggesting potential long-term benefits of this incentive-based approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Low-cost contingency management in community clinics: delivering incentives partially in group therapy. Alessi, SM., Hanson, T., Wieners, M., et al.[2016]

In a 16-week study involving 12 cocaine-dependent methadone patients, cash-based incentives of $50 and $100 significantly increased short-term cocaine abstinence compared to a control condition with no incentives.

The study found that cash-based incentives did not lead to increased cocaine use after receiving the incentives, suggesting they are a safe option for improving treatment outcomes in substance abuse interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management in cocaine abusers: a dose-effect comparison of goods-based versus cash-based incentives. Vandrey, R., Bigelow, GE., Stitzer, ML.[2022]

In a study of 255 substance users undergoing outpatient treatment, participants who were drug-free at the start (baseline negative) earned significantly more in contingency management (CM) incentives compared to those who were using drugs (baseline positive), with median prizes of $237 versus $44, respectively.

The findings suggest that tailoring CM interventions based on a participant's drug use status at treatment entry could enhance the effectiveness of abstinence-focused programs, as the majority of incentive expenditures were directed towards those who were already abstinent.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency Management Abstinence Incentives: Cost and Implications for Treatment Tailoring. Cunningham, C., Stitzer, M., Campbell, AN., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4203362/

Prize-based Contingency Management for the Treatment of ... Adding prize-based contingency management to behavioral support for substance use disorders can increase short-term abstinence but the effect does not appear ...

2. library.samhsa.gov library.samhsa.gov/sites/default/files/contingency-management-advisory-pep24-06-001.pdf

contingency-management-advisory-pep24-06-001.pdf Contingency management (CM) is a proven health care intervention with demonstrated effectiveness in treating a variety of substance use disorders (SUDs) ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5714694/

Contingency management treatment for substance use ... Contingency management (CM) interventions consistently improve substance abuse treatment outcomes, yet CM remains a highly controversial intervention and is ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S2949875923001303

Implementing an evidence-based prize contingency ... This article provides planning stage guidance to support programs' adoption of evidence-based prize CM for the treatment of stimulant use disorders.

5. legislativeanalysis.org legislativeanalysis.org/wp-content/uploads/2023/10/Contingency-Management-Fact-Sheet-FINAL.pdf

Contingency Management Fact Sheet Contingency management is a well-studied and effective method for treating substance use disorder, but for years, it received little support in the United ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10330855/

Implementing an evidence-based prize contingency ... This article provides planning stage guidance to support programs' adoption of evidence-based prize CM for the treatment of stimulant use disorders.

7. aspe.hhs.gov aspe.hhs.gov/sites/default/files/documents/a0cc6fcdb2968be95f60bb1c2c94eb70/contingency-management-sub-treatment.pdf

Contingency Management for the Treatment of Substance ... Between 2020 and 2021, the rate of deaths involving psychostimulants with abuse potential, such as methamphetamine, increased 34% -- a more ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12280170/

Financial Incentives for Substance Abstinence Substance use disorder (SUD) increased by 45% globally in the past 10 years, representing one of the largest increases in risk factors for disease.

9. recoveryanswers.org recoveryanswers.org/resource/contingency-management/

Contingency Management (CM) Contingency Management is often called motivational incentives, the prize method, or the carrot and stick method.

10. health.ny.gov health.ny.gov/health_care/medicaid/ebbrac/2025/docs/2025-04-02_contingency_mgmt_sud_rpt.pdf

Contingency Management for Stimulant Use Disorder Health ... based incentives to community reinforcement approach improves outcomes during treatment for cocaine dependence. American Journal on Addictions. 2011. 20:456 ...