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SAMHSA Increases Funding for Contingency Management Tenfold

Ten heart-shaped balloons represent a ten-fold increase inf funding for Contingency Management.

They say the Grinch’s heart grew three times that Christmas Day. SAMHSA, the Substance Abuse and Mental Health Services Administration, just announced a tenfold increase in individual limits for contingency management funds. The agency’s heart grew ten times that day.

Contingency Management is the opaque term given to the practice of paying people to get better. It’s not “money for nothing.” It’s money for staying in treatment, taking the prescribed medications, showing up for therapy sessions, and submitting to regular urine and/or blood tests. And it’s the best money spent in addiction recovery.

It’s hard work getting clean. There are no approved medications for treating addiction to stimulants such as cocaine and methamphetamine. There are medications for opioid use disorder and alcohol use disorder that help with cravings and other withdrawal symptoms. Temptations to relapse are everywhere, especially if patients can’t relocate. Yet the smallest amount of financial incentive is enough to keep many recovering addicts on the right track.

How little? How about $75 per year. That’s right, that was the old limit under SAMHSA guidelines as to how much they would reimburse financial incentives per patient per year. Seventy-five dollars. Per year. After an abundant number of studies showing that a little more money, more intelligently dispensed, improves results dramatically, SAMHSA raised the annual per-person limit to $750.

Contingency Management adds a missing layer to addiction care. We have drugs such as naloxone that can stop an overdose in its tracks. We have medications that can help break tough addictions in the relatively short period of time it takes to detox. What we haven’t had, until now, is something to get patients through the three to six months of therapy and lifestyle change needed to stay in recovery. Contingency Management provides that buffer.

In a news release welcoming the new guidelines, the American Society for Addiction Medicine (ASAM) and the American Academy of Addiction Psychiatry (AAAP) said:

[Contingency Management] is the only standard of care for Stimulant Use Disorder (StUD), involving substances like methamphetamine, cocaine, or prescription stimulants [and] is equally effective among those with concurrent stimulant and opioid use disorders (OUD).

SAMHSA has some pretty tough “required safeguards” to ensure that Contingency Management incentives are used appropriately. Some of the requirements include:

  • Recipients must be 18 years of age or older
  • Either prize-based or voucher-based protocols are permitted
  • Abstinence, SUD treatment attendance, and medication adherence are allowed to be used as incentivized behaviors
  • Receipt of the incentive is contingent upon the achievement of a specified behavior, consistent with the patient’s treatment plan, which has been verified with objective evidence
  • The minimum required duration of treatment is 12 weeks
  • Incentives must be provided immediately following verification that the incentivized behavior is achieved

SAMHSA offers Contingency Management training and guidelines for training to help organizations set up effective, compliant programs. Training includes such things as the core principles of Contingency Management, allowable incentives, immediacy of rewards, connecting with therapy, and documentation standards.

The documentation required includes the type of Contingency Management used, the specific rewards given, the outcomes required to receive the rewards, the proof patients met the required outcomes before receiving the rewards, and proof patients were not delayed or denied rewards they were entitled to.

The list of items that may not be used as incentives is amusing and revealing. Of course, no drugs or access to drug treatment is permitted as a reward. Also, no weapons, tobacco, pornography, or lottery tickets. Restrictions include “Cash, unrestricted cash equivalents, parenting time, and enhanced or expedited access to SUD treatment or recovery support services.”

The 15-page SAMHSA report concludes with a two-paragraph summary in support of greater use of Contingency Management (CM) for SUDs:

The body of evidence supporting the use of CM to promote lasting behavior change across a variety of populations with different SUDs is expanding rapidly. Promoting this health care intervention and offering it in conjunction with other treatment approaches that are applicable to populations of focus, is of the utmost importance given the increasing prevalence of SUDs and the need for effective treatments.

The provision of CM interventions that adhere to evidence-based practice is crucial. By providing services in an evidence-based manner, providers adhere to an important core principle of CM and individuals receive equitable, effective, and evidence-based, person-centered care. As the prevalence of SUDs increases, CM is an important intervention with life-changing and life-saving potential.

Written by Steve O’Keefe. First published January 16, 2025.

Sources:

“Using SAMHSA Funds To Implement Evidence-Based Contingency Management Services,” an Advisory From the Substance Abuse and Mental Health Services Administration, January 2025.

“APA applauds SAMHSA action to expand access to effective addiction treatment,” American Psychological Association, January 10, 2025.

“SAMHSA Updates Guidelines for Contingency Management: Maximum Incentives Increased to $750,” EIN Presswire, January 9, 2025.

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