Data-Driven Contingency Management Incentive Magnitudes: A Review.

Abstract

Interest in contingency management (CM) as a treatment for opioid and stimulant use disorders has increased because of the ongoing dual opioid/stimulant crisis, rising stimulant drug deaths, and demand for effective treatments for stimulant use disorder. The success of the US Department of Veterans Affairs nationwide rollout and the launch of California's Recovery Incentives Program provide evidence that this treatment can be translated into effective clinical practice. To provide data-driven inflation-adjusted incentive estimates for modern CM protocols that can be customized for intervention duration. It is essential for CM protocols implemented in clinical care to use efficacious, research-supported parameters, including incentive magnitude. This review included 112 published CM protocols that involved reinforcement of stimulant- and/or opioid-negative urine drug tests, categorized each protocol in terms of impact (small/medium/large effect size) relative to a non-CM comparator condition, and computed weekly inflation-adjusted incentive magnitudes for voucher- and prize-based CM protocols. Drawn from protocols with medium to large impacts on patient outcomes, weekly median magnitude estimates are $128/week for voucher protocols and $55/week for prize protocols. For the most common duration of 12 weeks, these estimates translate to $1536 for voucher and $660 for prize protocols. These incentive magnitude estimates can be used to inform clinical, policy, and advocacy related to CM implementation. Practical suggestions (eg, starting values, escalation) for building protocols that meet these incentive magnitudes are provided and implications are discussed.