Contingency management needs implementation science

Abstract

The gap between the evidence for contingency management (CM) and patients' ability to access it is so dire that, in Fall of 2021, the New York Times ran an article titled, 'This addiction treatment works. Why is it so underused?' The article elucidated the myriad of barriers that limit widespread access to CM in the United States including (but not limited to) insufficient funding, restrictive federal policies and provider attitudes/stigma. Readers of the article were left asking one of the most pressing public health questions of our time:'How do we close the gap?' Khazanov et al.[1] articulate a set of recommendations to answer this very question. Specifically, the authors recommend modifying CM protocols to align with harm reduction goals, investing in research on virtual CM delivery, incentivizing CM delivery for health providers and systems, removing obstacles to point-of-care testing, employing

Research is needed to guide contingency management implementation across populations and settings

“…Similarly, research on adapting CM for different populations, as Hirchak [4] and colleagues have done with American Indian and Alaska Native adults, is sparse. Becker's [2] current research on how to best implement CM in opioid treatment programs is among the first implementation trials of CM for stimulant use disorder. However, different implementation strategies may be needed for other populations or settings.…”