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Contingency management for substance use disorders: Efficacy, implementation, and training

Maxine Stitzer, PhD
Colin S Cunningham, PhD
Mary M Sweeney, PhD
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD


Contingency management is an effective behavioral treatment approach for patients with substance use disorders (SUDs) across wide range of substances, including those for which pharmacotherapy is unavailable or only partially effective. Contingency management is typically delivered as an augmentation to psychosocial treatment such as SUD counseling or cognitive-behavioral therapy.

Contingency management uses incentives to encourage treatment attendance and/or abstinence from alcohol/drug use. Contingency management interventions can be customized to some extent to address patient preferences or program needs, such as the resources available for the intervention.

This topic describes the efficacy, implementation, and training for contingency management. The theoretical foundation, indications, assessment, and components of contingency management for SUD are discussed separately. Other SUD treatments, including those for specific substances, are also discussed separately. (See "Contingency management for substance use disorders: Theoretical foundation, principles, assessment, and components" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Treatment of cannabis use disorder" and "Psychosocial interventions for stimulant use disorder in adults" and "Pharmacotherapy for smoking cessation in adults" and "Behavioral approaches to smoking cessation" and "Continuing care for addiction: Indications, features, and efficacy" and "Continuing care for addiction: Implementation".)


Clinical trials generally support the efficacy of contingency management for enhancing treatment attendance, increasing abstinence outcomes in treatment of substance use disorders (SUDs), and addressing health behaviors in substance users.

Treatment attendance — A review of 16 randomized clinical trials of contingency management targeting attendance concluded that findings were mixed but generally supportive of efficacy [1]. Six of the seven trials in adults treated for substance use had a higher rate of treatment attendance rates in patients assigned to contingency management compared with usual care. Contingency management can also be especially useful for improving patient follow-through rates at the start of treatment.

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Literature review current through: Nov 2017. | This topic last updated: Nov 07, 2017.
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