Expanding access to high-quality contingency management for the treatment of substance use disorder represents an important opportunity to accelerate efforts to address the overdose crisis, as well as the other substantial public health harms and costs related to untreated substance use disorders. This report to Congress, as required by Section 4127 of the Consolidated Appropriations Act, 2023, discusses opportunities and considerations for entities overseeing contingency management implementation to promote access to this intervention while ensuring fidelity to evidence-based practices, care quality, and program integrity.

Contents

• EXECUTIVE SUMMARY
• INTRODUCTION
• WHAT IS CONTINGENCY MANAGEMENT?
  • Treatment Approach
  • Evidence Base for CM for Treating SUDs
  • Case Study: The Veterans' Health System's Successful Nationwide CM Program
• BARRIERS
  • Concerns Regarding the Potential Application of Federal Fraud and Abuse Laws
  • Insufficient Reimbursement and Funding Limitations
  • Program Restrictions on SUDs for Which CM Can Be Used
  • Knowledge, Attitudes, and Stigma Related to CM
  • Importance of Strict Fidelity to Treatment Protocols
  • Limited Access to Robust Training and Mentoring Programs
  • Workforce Challenges
• OPPORTUNITIES TO IMPROVE ACCESS AND QUALITY AND STRENGTHEN PROGRAM INTEGRITY
  • Enhancing Clinical Approaches to CM Delivery
  • Provider and Organizational Standards to Promote Evidence-Based Practices for CM
  • Policy Opportunities to Expand Access to CM, Increase Treatment Quality, and Safeguard Program Integrity
• CONCLUSION
• REFERENCES
• ACRONYMS

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