Contingency management (CM) is an effective and well-studied intervention for substance use disorders (SUDs), and one of the few that has been demonstrated to work well for people with stimulant use disorders in particular. Nevertheless, its adoption in SUD treatment settings has been limited.
In 2020, SAMHSA’s State Opioid Response Grant (SOR) initiative included CM as an allowable activity to treat simulant use disorder and improve retention in care, which has the potential to expand CM implementation across the nation.
This study looks at a SOR-funded program to disseminate CM in Indiana -- how they developed their implementation plan and how well that implementation worked. Their experiences may provide helpful information for organizations or states/communities looking to also implement CM in their programs.
Indiana government and university partners developed a multi-component, statewide CM dissemination and implementation plan that included:
Researchers for this study collected data on provider/staff characteristics; CM knowledge and attitudes, readiness, and perceived barriers; and CM implementation at pre- and post-training workshop and at 3- and 6-month follow-up. In year 2, they also collected client-reported quality assurance data.
Staff (N=72) from 12 selected agencies attended the CM workshop. A little more than half (57%) reported some familiarity with CM, but only 14% had any prior CM training or experience. After the workshop, participants reported increased CM knowledge and confidence in their ability to implement CM.
Sites completed 3-7 technical assistance sessions and developed CM programs tailored to their organizations. By 6 months, 9 sites had begun CM implementation. These sites averaged 57 days of implementation (ranging from 25-122), engagement of 23 clients (range: 4-77), delivery of 208 CM reinforcers (gift card codes, range: 8-366), and per-client payouts of $33.77 (range: $11.24-$49.48).
Barriers to CM implementation reported by the sites included lack of time, client referrals, and resources (administrative and economic). Client-level quality assurance data indicated provider adherence to CM.
Overall, the multi-component training model funded by the SOR team was effective at yielding several new CM programs that operated successfully within SAMHSA’s guidelines.
Sites participating in this SOR-funded training and implementation opportunity expressed positive feedback about their experiences. Other state SOR programs may want to consider similar models for implementation, as Indiana’s model was successful at increasing CM knowledge and confidence for providers and staff and got 9 of 12 sites up and running in just 6 months.
Programs should also note, however, that organizational barriers like readiness/capacity, turnover, and buy-in remained a challenge for the Indiana sites, suggesting that addressing these issues earlier on in the implementation process may be useful.