Contingency management (CM), an evidence-based therapy rooted in behavioral economics, provides incentives or rewards for a desired behavior and has been shown to be effective for a broad range of substance use disorders and associated problems. Perhaps most notably, CM, where participants receive vouchers exchangeable for retail items, has been shown to help those addicted to stimulants like cocaine and methamphetamine abstain from drug use and remain in treatment starting with seminal clinical trials conducted by Vermont Center on Behavior and Health (VCBH) investigators Drs. Higgins, Heil, Sigmon, and others in the 1990s and systematically replicated nationally and internationally over the almost 30 years.
A recent article in the New York Times, “This Addiction Treatment Works. Why Is It So Underused?” sought to examine why CM is not being implemented in treatment programs throughout the United States. Dr. Richard Rawson, professor of psychiatry at the University of Vermont and a faculty member at the VCBH was interviewed for the article. Dr. Rawson who led seminal trials on CM for treating methamphetamine use disorder while on the UCLA faculty, explained that since addiction is a chronic brain disease, “treatments need to be designed to accommodate this reality.” The article also importantly delves into the reluctance by policy makers to allow Medicaid to reimburse clinics for the cost of incentives due to concerns about potential fraud, certainly not a concern specific to CM. There is growing sentiment that it is time for Medicaid to enlist this evidence-based treatment in efforts to improve the effectiveness of addiction treatment because of the overwhelming scientific evidence supporting the efficacy of CM and a resurgence of stimulant addiction among those with opioid use disorder.
Dr. Rawson and collaborators from across the U.S. are leading efforts to promote this policy change. NIH-funded CM research is continuing at VCBH, with Drs. Higgins and Heil leading clinical trials showing its efficacy in promoting smoking cessation and improving birth outcomes among pregnant women and preventing unplanned pregnancies among women with opioid use disorder, respectively.