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1 [1] (June 5, 2024)

handle is hein.crs/govepfh0001 and id is 1 raw text is: Congres Informinq ib on I Research ervice Ieg~ I t~ve ci ba e ii 'e 1914 0 June 5, 2024 Contingency Management for Substance Use Disorders Treatment for substance use disorders (SUDs) typically involves pharmacological or psychosocial therapies. For instance, certain medications are used in treatment for alcohol, tobacco, or opioid use. Meanwhile, for substances such as methamphetamine, cocaine, and marijuana, there are no comparable Food and Drug Administration (FDA)- approved medications for treatment. Research shows that psychosocial interventions are the most effective treatment for stimulant use and marijuana use. More specifically, an intervention known as contingency management (CM) has thus far had the most empirical support for effectiveness. This In Focus provides an introduction to CM, examples of federal support for CM, and an overview of certain federal fraud and abuse laws that may apply to CM programs. ackground Contingency management is a behavioral intervention that involves giving individuals tangible rewards to reinforce desired behaviors. CM for SUDs comes in several forms, but all provide something tangible of value to participants for achieving a target behavior-usually participation in treatment, or reduction or elimination of substance use (often measured through urine screenings). Rewards (known as motivational incentives, reinforcers, or contingencies) can include privileges, prizes, vouchers for goods or services, gift cards, or direct cash payments. Some CM programs guarantee a reward-a set amount per opportunity or an escalating schedule of increasing value as treatment progresses. Other CM methods provide chances for awards via pulls from afishbowl containing incentives of varying value. One notable finding in the research is that higher monetary value and more frequent and immediate delivery of rewards are typically associated with a larger effect on behavior change (Figure 1). For example, one study found that immediate rewards increased steadily over the course of treatment performed better than a single lump sum. Other studies have found little difference between fixed versus varying amounts of rewards. Most studies have generally found that higher rewards are more effective. Yet no consensus currently exists in the empirical literature on specific thresholds for incentives in CM. Generally, a total maximum award of under $100 is considered low, while treatments providing totals of over $1,000 are considered high. Although most CM remains in person, new technologies have allowed for greater flexibilities in treatment delivery. Digital therapeutics such as smartphone applications or internet-based methods can provide remote monitoring and incentive delivery. Technology-based CM interventions that allow patients to participate remotely avoid common obstacles to SUD treatment, such as requirements for frequent in-person visits. Figure I. Components of Effective Contingency Management Source: CRS, based on Sterling M. McPherson, Sara Parent, Andre Miguel, et al., Contingency Management is a Powerful Clinical Tool for Treating Substance Use Research Evidence and New Practice Guidelines, Psychiatric Times, vol. 39, no. 9 (September 9, 2022). SUD treatment using CM does not have a prescribed time period. Many clinical evaluations of CM have followed 12- or 16-week schedules, though many patients may need longer intervals to achieve desired outcomes. Practitioners can discontinue CM if participants stop responding to the treatment. Participants can engage in a course of CM treatment multiples times, as needed. CM is often used in combination with other therapies and has been found to be effective for diverse populations. For example, CM can be paired with medication as an adjunctive treatment for SUDs. Evaluations of CM have generally found it to be cost-effective given the potential benefits of reduced substance use. The long-term effects of CM on substance use await further research. Federai Support for CM Executive agencies responsible for SUD treatment-such as the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute on Drug Abuse (NIDA), and the Office of National Drug Control Policy (ONDCP)-promote the use of motivational incentives via CM to improve treatment outcomes for certain SUDs. For example, the Department of Veterans Affairs (VA) has integrated CM into many of its intensive outpatient SUD treatment clinics for veterans since 2011. While some people may have moral or practical concerns about paying substance users to reduce drug use (or concerns about fraud), federal programs have generally supported the use of CM. 0

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