One of the more fascinating results of the large body of research on addiction treatment and recovery is that many of the same techniques that get people hooked can be used to get them unhooked.

People can be weaned off cigarettes with nicotine patches. People can be weaned off nicotine pouches with patches. Addicts can be weaned off opioids with methadone (an opioid) and buprenorphine (an opioid).

Triggers that cause people in recovery to have cravings can be reprogrammed into benevolent triggers that launch healthy habits. New routines can be substituted for old routines, resulting in a firmer attachment to healthy habits.

Now, a study from Texas Tech University is showing how using contingency management is improving outcomes in treating substance use disorders (SUDs). Contingency management involves paying participants — usually very small amounts — to adhere to a treatment program.

The Texas Tech study went one step further. They borrowed a technique from gaming disorder and gambling disorder to keep patients invested in their recovery: prizes!

The study was conducted in two rounds at addiction medication clinics in Ontario, Canada. The first round, in 2020, involved 17 participants and the second round, in 2022, involved 29 participants. Three patients dropped out in the first round, four in the second round, in all cases within three weeks into the 12-week program. That’s an average dropout rate of about 15%.

Twice each week, patients agreed to submit to urine analysis. If that analysis was negative for benzoylecgonine, amphetamines, and/or methamphetamine, patients were invited to reach into a box and pick out a prize. The study was limited to stimulants because other protocols were available for opioid use disorder and alcohol use disorder, but not for stimulants.

The prize ranges included “small, medium, large and jumbo.” Prizes included:

[…] candy or small toiletries for small prizes, household items such as coffee tumblers or frying pans for medium prizes, small appliances such as coffee makers for large prizes, and one or two jumbo prizes like electronics or tablets.

There was no uniformity in prizes because the entire operation relied upon donations and did not use government funding. Prizes available depended upon what sponsors donated. The cost per-person for 24 twice-weekly prize draws was C$250-C$300, or about $10 per person, per week.

Patients who participated in the contingency management program achieved an average of 8.3 weeks of consecutive abstinence, with a total of 10.7 weeks of abstinence in a 12-week period. The authors say that these results are in line with previously reported success rates for contingency management programs.

With such small amounts involved, it’s not really the money that motivates participants — it’s the chase. By adding chance to the outcome and including a few highly-coveted prizes, contingency management uses gamification to strengthen reward response and nurture reward system repair.

The process is explained by Dr. Hanna Pickard, author of a recent article on drugs and cravings for the journal, Mind & Language: 

[Contingency management] is a highly effective therapeutic modality which in effect structures a person’s environment to mirror forced-choice animal studies: Alternative rewards, such as small prizes, vouchers, money — or skills training and employment — are available on condition of abstinence.

What this study shows, and what other studies have consistently shown, is that contingency management works better than any other therapy at getting patients to adhere to an addiction treatment program. The expense for these programs is laughably small compared with the costs of leaving addiction untreated. 

If you want people to improve, pay them. And if you want them to improve quickly, make it a game. It takes very little to fund the most successful addiction treatment program we are aware of: contingency management. Seems like a rewarding use of funds for one of America’s billionaires looking for the biggest bang for their beneficial bucks.

Written by Steve O’Keefe. First published September 18, 2025.

Sources:

“Real-World Implementation of Contingency Management and Benefits of a Controlled Environment ‘Head Start’,” Brain and Behavior, September 2025.

“Craving for drugs,” Mind & Language, June 28, 2024.

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