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Dissemination of Contingency Management for the Treatment of Opioid Use Disorder

  • SI: Behavior Science Contributions to Public Policy
  • Published:
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Abstract

Contingency management is an intervention for substance use disorders based on operant principles. The evidence base in support of contingency management is massive. It is effective in treating substance use disorder in general and opioid use disorder in particular. Dissemination has remained slow despite the urgency created by the opioid epidemic. Key barriers include a lack of expertise, time, and money. Implementing contingency management with smartphones eliminates the need for special training. It also solves logistical issues and requires little time on the part of clinicians. Thus, remaining barriers relate to cost. Federal anti-kickback regulations complicate solutions to the cost barrier. Other important regulatory challenges related to cost include the lack of billing codes and the difficulty of obtaining FDA approval for digital therapeutics. Even after the cost barrier is overcome, provider adoption is not guaranteed. Incentivizing providers for collaborative care may increase adoption and generate referrals. Recently proposed legislation and governmental policy statements provide optimism regarding the near-term large-scale adoption of contingency management in the treatment of opioid use disorder.

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Notes

  1. Dallery et al. (2015) and Andrade and DeFulio (2017) offer chapter-length coverage of CM including descriptions of procedural differences across variants. For a book-length treatment, see Higgins et al. (2007). For instructions regarding CM design and implementation considerations see Meredith et al. (2014), and for a book-length treatment of this topic, see Petry (2011).

  2. In addition to adoption by Medi-Cal, positive signs of broad support for CM include adoption of Prescription Digital Therapeutics that include CM by MassHealth (Massachusetts’ Medicaid program), and ongoing Medicaid pilot programs in other states such as Vermont, as well as State Bill S7543 under consideration in the New York State Senate’s 2021–2022 session. Review of press releases posted to the websites of companies that provide CM services (e.g., Affect Therapeutics, DynamiCare Health, Pear Therapeutics) illustrates that these companies have been increasingly successful in securing direct service contracts from payers such as Blue Cross Blue Shield and Aetna, among others. This recent increase in support adds to prior key dissemination victories such as inclusion of CM in NIDA Clinical Trials Network studies (e.g., Peirce et al., 2006) and nationwide adoption of CM by the U.S. Department of Veterans Affairs (Petry et al., 2014).

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Funding

This research was supported by grants R41DA049390 and R44DA055396 from the National Institute on Drug Abuse.

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  1. Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5439, Kalamazoo, MI, 49008, USA

    Anthony DeFulio

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  1. Anthony DeFulio
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Correspondence to Anthony DeFulio.

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The author has served as a research consultant for DynamiCare Health, Inc. This company provides contingency management services for people with substance use disorders.

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DeFulio, A. Dissemination of Contingency Management for the Treatment of Opioid Use Disorder. Perspect Behav Sci 46, 35–49 (2023). https://doi.org/10.1007/s40614-022-00328-z

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