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Contingency management in drug treatment

An evidence-based treatment intervention

Contingency management (CM) is an evidence-based treatment intervention recommended by the National Institute for Health and Clinical Excellence (NICE). It is based on principles of behaviour modification and aims to incentivise and then reinforce changes in behaviour with the aid of vouchers, privileges, prizes or modest financial incentives that are of value to the client.

Providing incentives is supported by government as a way to “nudge” people to change their behaviour in a positive direction across a wide range of health and social policy domains [i]

Used properly and implemented carefully (see next section), CM can be a useful intervention within a balanced treatment system. Alongside other interventions, it can be used to encourage and support:

  • abstinence from drugs of dependence, usually alongside substitute medication and relapse prevention
  • engagement in recovery related activities
  • engagement in treatment by incentivising attendance
  • Improved compliance with health promotion, such as preventing BBVs, an example of which is hepatitis B vaccination.

NICE recommended:

“Drug services should introduce contingency management programmes… to reduce illicit drug use and/or promote engagement with services for people receiving methadone maintenance treatment. … Where possible, implementation in the NHS should draw on the experience so far (albeit limited) of contingency management in the NHS and on the experience of agencies such as the National Treatment Agency for Substance Misuse (NTA) in the implementation of service developments in drug misuse.”[ii]

In 2009 the NTA conducted a demonstration programme that looked at the implementation of CM in selected drug treatment services. Since the programme concluded, CM for drug use has been included as an intervention in the NDTMS modality codes. Meanwhile, the expertise of the pilot sites has been placed at the disposal of the ConMan programme of five linked research studies that started in 2009 and runs to 2014.

The aim of the study is to develop a UK evidence base for contingency management in addiction treatment. The programme, which is funded by a National Institute for Health Research (NIHR) Programme Grant, is being led by the South London & Maudsley (SLaM) NHS Foundation Trust, but is a collaborative venture by investigators based at three London NHS trusts and universities.

[i] Behavioural Insights Team (2010) Applying behavioural insight to health. Cabinet Office

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