Contingency Management is Gaining Favor for Treating Addiction

Article published in WSU Insider.

Washington State University scientists have published study after study showing that reinforcement-based addiction treatment works. WSU is considered a leader in the field, in fact.

Contingency management, or CM, is a behavioral therapy that rewards people for avoiding the habits they’re trying to quit. Someone in CM treatment might visit a clinic regularly for a urine test, and if it’s drug-negative, they immediately get a gift card or prize.

Despite the evidence in its favor, uptake of the treatment has been slow. Federal and state regulations have been a major hurdle, as has a mindset that people shouldn’t be paid to abstain from drugs and alcohol.  

That’s now changing.

Overdose deaths from stimulants — primarily cocaine and methamphetamine — have risen sharply, and CM is widely acknowledged as the most effective treatment for addiction to stimulants.

Based in part on successful pilot programs led by WSU researchers, the state of Washington last year approved a waiver so contingency management can be offered as treatment to patients covered by Medicaid, the largest funding source for substance use treatment in the nation. California has done the same.

And in November the U.S. Department of Health and Human Services issued a report to Congress urging greater access to the treatment.

“There is immense need to expand the implementation of CM, as it has tremendous potential to address the nation’s high rate of overdose deaths and, in particular, the increasing rate of stimulant-involved overdose deaths,” the report said.

Contingency management works by rewiring reward pathways in the brain that have been hijacked by drug use.

Said John Roll, vice dean of research at the WSU Elson S. Floyd College of Medicine and a pioneer in the therapy at the university, “All organisms have evolved to be exquisitely sensitive to consequences of their behavior.”

Studies show CM is effective in treating a range of addictions. Besides stimulants, those include alcohol, cannabis and tobacco, and in conjunction with medications, treating opioid use disorder. CM works with a diversity of clients, including people experiencing homelessness or who have mental health issues.

WSU researchers are working to “innovate the treatment” and make it available to patients in new ways, said Michael McDonell, a professor at the WSU Elson S. Floyd College of Medicine. For example, researchers are developing a smartphone app that will make CM treatment more available in rural areas. And they’re piloting CM treatment in supportive housing facilities that provide services for people with physical and mental health conditions, making it more convenient for participants. Roll said the potential uses of contingency management are broad. He added, CM “isn’t the be-all to end-all. But it’s a useful tool to help people achieve goals.”