Contingency Management (CM) is a proven, practical treatment that rewards people for positive actions like clean drug tests, attending sessions, and sticking with care plans; it is considered a first‑line approach for stimulant use disorders such as methamphetamine and cocaine use.
What is Contingency Management?
Contingency Management is a behavioral therapy that uses small, immediate rewards (like vouchers or gift cards) to reinforce healthy behaviors, such as submitting drug‑free urine samples or showing up to treatment appointments.
It is often combined with counseling (like cognitive behavioral therapy), telehealth programs, and medications when relevant (for example, medications for opioid use disorder if a person also uses opioids).
Why CM for Stimulant Use?
There are currently no FDA‑approved medications for stimulant use disorder, so behavioral methods like CM play a key role in driving results for people using methamphetamine or cocaine.
CM has decades of research behind it and is recommended as a first‑line option for stimulant use; it improves abstinence, keeps people engaged in care, and helps with adherence to related health treatments.
How CM Programs Work in Simple Steps
- Define the goal: common targets are stimulant‑negative urine tests, keeping therapy appointments, or completing program milestones.
- Choose the schedule: programs use either voucher‑based reinforcement (earn set values) or prize‑based reinforcement (drawings with variable rewards) on a clear schedule.
- Deliver immediate rewards: incentives are given right after the behavior, which builds strong habit loops and motivation.
Types of CM: Voucher vs. Prize-Based
- Voucher CM: clients earn vouchers with fixed or escalating values for each success; values typically rise with continued success to encourage streaks.
- Prize CM: clients earn chances to draw for prizes of varying values; it can achieve similar outcomes at lower average costs if implemented correctly.
What Incentive Amounts Are Effective?
Evidence shows that larger potential incentive amounts tend to produce stronger outcomes, though programs balance cost and fairness.
Meta‑analyses suggest higher daily magnitudes (e.g., more than 1616 USD/day in some protocols) improve effect sizes, with many 12‑week programs historically totaling a few hundred dollars in expected incentives.
Important Update on Funding and Caps
In 2025, U.S. federal guidance increased the allowable annual incentive cap under eligible SAMHSA grants to up to 750750 USD per patient per year, with guardrails like using items or gift cards (not cash) and adhering to evidence‑based models.
This update helps programs scale CM responsibly and maintain integrity, using approved voucher or prize‑based structures with equal access for participants.
Who Benefits Most?
CM is especially effective for people with stimulant use disorders, including methamphetamine and cocaine, and can be delivered in outpatient clinics or via telehealth.
It also supports people with multiple needs by reinforcing attendance, medication adherence, and preventative health steps (e.g., testing for HIV, hepatitis, or TB).
CM for People Using Both Stimulants and Opioids
Many people use stimulants alongside opioids; CM can be paired with medications for opioid use disorder (MOUD) to reduce stimulant use and improve engagement.
Across dozens of trials, CM has been linked to higher abstinence from stimulants and other substances when integrated into structured care.
Real‑World Adoption and Training
CM is moving from research into real‑world programs; states and systems are building reimbursement pathways, and free trainings help teams implement CM with fidelity.
Health agencies and city governments have encouraged CM as a high‑evidence option for methamphetamine use disorder, noting the urgency and potential impact.
What Does a Typical CM Visit Look Like?
- Quick check‑in and testing (e.g., urine test) to verify the target behavior.
- Immediate feedback: if the test is clean or the milestone is met, the participant receives the incentive or draw entry on the spot.
- Escalation: streaks of success may earn higher values, and missed targets may reset the value to encourage consistent progress.
Common Goals to Reinforce
- Negative stimulant tests (abstinence from methamphetamine/cocaine).
- Attendance at therapy, IOP groups, or telehealth sessions.
- Adherence to medications or health screenings when applicable.
Evidence Snapshot
Studies show that both voucher and prize CM can significantly improve outcomes for stimulant use disorders, with cost‑effective designs still delivering benefits.
Program planners should match incentive magnitude and duration to the complexity of the goal and patient needs, adjusting for severity and multi‑target protocols.
Why Immediate Rewards Matter
Immediate rewards are psychologically powerful; they close the gap between effort and payoff, helping the brain learn and repeat sober, health‑supporting behaviors.
Over time, consistent reinforcement builds new routines and supports long‑term change beyond the program window.
Telehealth and Digital CM
CM can be delivered in person or via telehealth, expanding access for people in rural areas or with transportation barriers while maintaining rapid verification and rewards.
Programs can use digital tools for appointment tracking and e‑gift cards to deliver incentives within required rules.
Designing a CM Program: Practical Tips
- Keep rules simple and clear: what behavior earns a reward, how often, and how much.
- Use fair, transparent schedules and ensure everyone has equal access to incentives under the same criteria.
- Combine CM with counseling (e.g., CBT) and, if relevant, MOUD, to address broader recovery needs.
Safety, Ethics, and Compliance
CM incentives must support recovery and well‑being; programs typically use vouchers or gift cards for necessities and services, not cash.
Maintain data privacy, accurate records, and fidelity to evidence‑based models to protect clients and ensure program quality.
Addressing Common Concerns
- “Isn’t CM just paying people?” CM is a clinical intervention that rewards health behaviors, similar to how step‑tracking programs reward exercise; research shows it works and is cost‑effective.
- “Won’t people game the system?” Clear rules, testing, and documentation minimize misuse, and equal‑opportunity structures ensure fairness.
Getting Started or Finding Help
Ask local treatment centers or telehealth providers if they offer CM for stimulant use disorder and how their schedule works.
Clinics can access implementation guides, trainings, and federal advisory documents to set up compliant CM services.
Key Takeaways
Contingency Management is one of the most effective, easy‑to‑understand treatments for stimulant use disorder because it rewards the right behaviors quickly and consistently.