Hundreds of rehab programs for drug and alcohol abuse exist in the United States and offer varying forms of treatment based on the type of drug addiction a person has and other factors.
Medications such as methadone, for instance, can be effective for treating opioid addiction. But for some drug addictions, the only treatments proven to be effective are psychosocial treatments.
One example of this is contingency management, or CM, which offers small monetary or prize-based incentives for abstaining from drug use. Thus, positive reinforcement.
However, despite its efficacy for treating various substance use disorders, it’s illegal to provide this type of drug abuse treatment to many patients under federal and state laws.
Which States Allow Contingency Management Programs?
Contingency management is legally offered by certain addiction treatment providers across the U.S. for stopping cocaine use, meth use, and the use of other addictive drugs.
The Department of Veteran Affairs (VA), for instance, has been offering this treatment to veterans through the VA system for decades—with promising outcomes.
But according to Health Affairs, this treatment is rarely available in community-based treatment settings, largely due to federal regulations prohibiting federal funding for CM interventions.
Is Contingency Management Treatment Illegal?
Contingency management is not illegal in all states, or for all people seeking substance abuse treatment.
But, the fact that contingency management offers monetary reinforcers—such as gift cards or vouchers— for people who demonstrate abstinence is a violation of federal law and laws in certain states.
What Does Federal Law Say About Contingency Management?
Under federal law, it is illegal for rehab programs funded by federal or state dollars to provide incentives, which are legally considered “kickbacks” or “inducements,” above annual limits.
Federal law places this limit at $75 in monetary value annually. The same also applies to patients who are enrolled in health plans funded by federal or state dollars.
This federal law can apply to:
- inpatient rehab programs
- residential rehab programs
- outpatient rehab programs
Furthermore, some states also have their own separate laws with limitations on the provision of incentives. These state and federal laws are sometimes referred to as “anti-kickback statutes.”
California’s Move To Expand Contingency Management Treatment For Substance Abuse
One recent development in expanding this type of treatment is legislative action in California, where lawmakers have passed legislation that would essentially make CM legal under state law.
With this, California could become the first state to allow federal dollars to fund and expand contingency management programs in the state, particularly for people enrolled in Medi-Cal.
In addition, California Governor Gavin Newsom is also seeking permission from the federal government to use federal tax dollars to pay for contingency management through Medicaid.
What Does Contingency Management Treat?
Contingency management can be effective for treating various forms of substance abuse and drug addictions and is currently a leading known treatment for stimulant disorders.
Types of drug abuse and addiction it can treat:
- cocaine dependence
- methamphetamine addiction
- alcohol dependence
- opioid addiction
- marijuana abuse
- nicotine dependence
There’s also evidence to suggest it can be effective for people with co-occurring mental health and substance use disorders, or a dual diagnosis.
What Are The Barriers To Contingency Management Programs?
Although backed by the federal U.S. National Institute on Drug Abuse (NIDA) and SAMHSA, contingency management is still a controversial treatment among some healthcare providers.
While legal barriers serve as one of the primary barriers to ensuring access to this treatment for people with drug addiction, stigma among clinicians and other experts is another enduring obstacle.
How Much Do Contingency Management Programs Pay?
The amount of money or type of prize incentive contingency management programs offer varies among treatment providers. In some instances, they may be subject to state regulations.
But by design, this program typically offers small incentives—ranging from $1 to $25 or more in monetary value—multiple times over the course of a multi-week or multi-month period.
That is, if you meet the requirements to receive the prize incentive. Incentives are often provided in the form of gift cards, coupons, or other prizes upon demonstrating you’re drug-free.
Typically, this is accomplished by providing a drug-free urine sample. At the end of the program, participants who stay sober may earn anywhere from tens to hundreds of dollars.
Contingency Management As One Component Of A Treatment Program
Contingency management is an evidence-based practice that’s associated with higher retention rates and can effectively help people continually and actively stay sober.
Incentivizing someone to stay sober is a form of operant conditioning that can help counteract the effects of addiction on the brain. But this type of behavioral treatment isn’t always offered alone.
Achieving long-term addiction recovery is a process that may also be aided by other drug abuse treatments, such as cognitive behavioral therapy (CBT), support groups, or residential care.
Find More Information About Contingency Management Treatment Near You
If you’re looking for contingency management treatment for yourself or a loved one with drug addiction, we may be able to help you identify treatment options near you.
Call our helpline today to learn more and to find a treatment program for addiction that’s right for you.Article Sources
- American Journal of Preventive Medicine — Financial Incentives for Exercise Adherence in Adults: Systematic Review and Meta-Analysis
- Archives of General Psychiatry — Effects of Lower-Cost Incentives on Stimulant Abstinence in Methadone Maintenance Treatment
- CBS News — California governor, lawmakers want state to pay addicts to get sober
- Health Affairs — Contingency Management: A Highly Effective Treatment for Substance Use Disorders and the Legal Barriers That Stand In Its Way
- The New Republic — What If We Pay People to Stop Using Drugs?
- U.S. Department of Veteran Affairs (VA) — How VA uses contingency management to help Veterans stay drug free
- U.S. National Institute on Drug Abuse (NIDA) — Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine)
- U.S. National Library of Medicine: NCBI — Contingency management: New directions and remaining challenges for an evidence-based intervention