Community opioid treatment perspectives on contingency management: Perceived feasibility, effectiveness, and transportability of social and financial incentives.

Meta-analyses of contingency management (CM) in addiction treatment settings note reliable efficacy, and effectiveness trials conducted by the National Drug Abuse Treatment Clinical Trials Network (CTN) document its positive impacts when employed at community-based clinics. Still, the treatment community has been slow to embrace CM relative to other behavior therapies like motivational interviewing, relapse prevention, and 12-step facilitation. Treatment community reluctance toward contingency management (CM) may be better understood by eliciting views of its feasibility, effectiveness, and transportability when social versus financial incentives are utilized. This mixed method study involved individual staff interviews representing three personnel tiers (an executive, clinical supervisor, and two front-line clinicians) at 16 opiate treatment programs. Programs were chosen from 8 regions of the U.S., with one CTN-affiliated and one non-CTN-affiliated treatment center selected for participation from each region. Interviews included Likert ratings of feasibility, effectiveness, and transportability of each incentive type, and content analysis of corresponding interviewee narrative. Multi-level modeling analyses indicated that social incentives (such as letting clients who have been clean earn take-home doses and cut back on in-office visits, e.g.) were perceived more feasible, more effective, and more transportable than financial incentives, with results pervading personnel tier. Content analysis suggested that the more positive perception of social incentives was most often due to expected logistical advantages, positive impacts on patient quality-of-life, and philosophical congruence among staff. Weaker perception of financial incentives was most often influenced by concerns about costs, patient dissatisfaction, and staff philosophical incongruence. Implications for CM dissemination are discussed.