Contingency management (CM) uses motivational incentives, including cash and/or vouchers, to help treat addictive disorders, including opioid addiction. Incentives are awarded or withheld contingent on whether the client meets treatment goals such as maintaining abstinence or attending meetings. CM is currently the only evidence-based approach in treating stimulant use disorder (as in California) but also shows promise as an adjunct to medications for opioid use disorder (MOUD). A recent meta-analysis found it to be effective in helping patients stay abstinent, remain in treatment, adhere to medication regimens, and reduce polysubstance use, e.g., combining stimulants with opioids. 

Even though MOUD are highly effective treatment options for opioid addiction, improved outcomes are only realized when a person is retained in treatment. Unfortunately, only around half of people who start medications for their opioid addiction are retained in care one year later. CM as an adjunct to medication treatment may help to increase retention rates. 

According to news reports, a recent decision by the U.S. Office of the Inspector General now allows one CM program to award incentives sufficient to be most effective in modifying addictive behavior. This sets a precedent for other programs to follow suit, thus removing a barrier to wider adoption of CM in opioid addiction treatment,

Some CM-specific programs such as DynamiCare* use a digital platform (virtual meetings and smartphone apps) to interact with clients and deliver incentives, but the approach can also be integrated into a comprehensive opioid addiction treatment program as described here* and here.* Communities may wish to explore adding CM to locally available opioid treatment programs.

*Disclaimer: These programs are cited to illustrate CM applications, not as an endorsement.