Background: This paper discusses the design and implementation of a pay-for-performance (P4P) initiative within the context of alcohol and drug addiction treatment. Though the use of P4P programs to enhance the quality of health care services has been increasing for certain chronic health conditions, these programs have been underutilized by providers of addiction treatment. Methods: Recently, as part of a new contractual agreement for patient care, a nationally-based alcohol/drug treatment provider collaborated with a major insurance payer to identify a set of metrics related to the quality of care. Selection of the metrics was guided by the Institute for Healthcare Improvement (IHI)'s Triple Aim, with measures representing the patient experience, patient engagement with services, and readmission to treatment services. Prior to the beginning of each contract year, targets for each metric were set based on historic baseline data, and the treatment provider was financially incentivized by the insurance payer to achieve the targets. Results: A higher number of metrics targets were achieved in the second year of the contract compared to the first. Conclusions: The experience of both organizations thus far demonstrates that implementation of P4P initiatives within addiction treatment is feasible, provided that both parties are committed to the success of the endeavor. Future studies should examine the efficacy of these programs with a research-based methodology.