A retrospective comparison of two state-funded smartphone-based contingency management programs with different...

Contingency management, an incentive-based intervention for substance use disorders, has strong empirical support but limited availability. In the United States, this is partly attributable to policies that limit the amount of incentives that can be used in these interventions when funded by some agencies. The recent completion of two pilot programs of a smartphone-based contingency management intervention provided the opportunity for a natural comparison of programs that differed in their incentive values and behavioral targets.

This retrospective study included participants (n = 262) in outpatient treatment who met the DSM-5 criteria for stimulant use disorder. Patients in the low-value program (n = 169) could earn up to $75 over 16 weeks for app engagement and completion of salivary drug tests. Patients in the moderate-value program (n = 93) could earn up to $599 over 26 weeks for app engagement and negative drug test results. The primary outcome was engagement with program activities (e.g., surveys, therapy modules). The secondary outcome was the rate at which participants submitted tests demonstrating abstinence from substance use.

Beta regression controlling for demographic differences showed that patients in the moderate-value incentive program completed surveys and therapy modules at significantly higher rates compared to patients in the low-value incentive programs. Similarly, moderate-value program patients submitted tests demonstrating abstinence at a significantly higher rate.

Larger financial incentives, abstinence-targeted rewards, and longer intervention duration were jointly associated with better engagement and abstinence outcomes. Policies should support evidence-based contingency management design features.