Contingency Management in Canadian Addiction Treatment: Provider Attitudes and Use

Contingency management (CM) is an evidence-based treatment for addictive disorders that is underused in clinical practice. The attitudes of staff are frequently reported as barriers to the uptake and use of evidence-based treatments, including CM. Understanding these barriers is an important step in implementation and could have an impact on an intervention's efficacy. We investigated Canadian addiction treatment providers' (ATPs) beliefs and use of CM.

Managers of addictions treatment programs across Canada were contacted between March 2019 and February 2021 and asked to forward our survey to interested ATPs (N = 298 respondents; female = 210, male = 80, other = 8) who offered services to help clients reduce substance use in their program(s).

Providers in 103 programs across all 10 Canadian provinces participated (26.2% response rate). Most were not familiar with CM and reported largely neutral attitudes toward it. Training-related barriers to CM were the most highly endorsed compared with other barriers. Most ATPs reported a desire for additional training in CM. Some denied wanting additional training because of concerns about CM, which was consistent with previous literature.

Our findings suggest that successful implementation of evidence-based treatments requires consideration of provider-level characteristics including attitudes, knowledge, and concerns about the intervention. Results highlight the importance of integrating training with efforts to address systemic-level barriers to implementation.