Contingency management is a proven evidence-based best practice for all substance use disorder (SUD) treatments.  It is recognized by NIH/NIDA as an effective intervention for SUD especially when there is no available FDA-approved medication assisted treatment (MAT), for example with methamphetamine use disorders (MUD).  Contingency Management (CM) is a behavioral technique that seeks to encourage positive behavior change (e.g., abstinence, moderation, safer use) by providing positive reinforcement (i.e., desirable consequences) when clients meet treatment goals and by withholding reinforcement when patients engage in an undesired behavior (e.g., drug use). For example, consequences for abstinence or less substance use may include positive reinforcement in the form of vouchers exchangeable for awards or prizes while consequences for alcohol/drug use may include nonreinforcement by withholding vouchers. Reinforcing or punishing consequences of no reinforcement may be contingent on objective evidence of drug use (e.g., urine screens) or on another important behavior, such as compliance with a medication regimen or regular clinic attendance.

CM procedures are frequently implemented with written contracts that detail the desired behavior change, duration of intervention, frequency of monitoring, and potential consequences of the person's success or failure in making the agreed upon behavior changes. Generally points toward prizes or rewards are not taken away with undesired behaviors such as an unfavorable urine drug screen, and rewards are usually given after several positive behaviors in a ratio of 1:4 approximately.  Contingency Management is the most studied and considered the most promising psychosocial approach to be added to treatment as usual.

The Amador Recovery Project (ARP) offers Contingency Management for persons using methamphetamine.  It is based on the UNM ASAP model in Albuquerque.  This approach in Las Cruces is often combined with harm reduction recommendations and practices, primary care to address other health problems, medication management for psychiatric issues related to meth (e.g., paranoia, hallucinations, depression) and dental/oral care (e.g,. cleanings or prophylaxis).  All clients with MUD have individualized, person-centered services for the most appropriate different combination or mix of care/services regarding methamphetamine. Contingency Management at Amador Recovery is combined with individual counseling, case management, support groups, classes, and adjunctive therapies such as acudetox (i.e., ear acupuncture).  ARP is also a provider in Doña Ana County’s LEAD (Law Enforcement Assisted Diversion) initiative to offer treatment instead of incarceration for persons using methamphetamine and/or opioids.

REFERENCES/RESOURCES
AAC Contingency Management
UW Alcohol & Drug Abuse Institute:  Motivational Incentives
Very Well Mind: Overview of Crystal Meth (Methamphetamine)
Drug-Free World:  What is Methamphetamine?
5 Stages of Meth Recovery
UMKC Methamphetamine Handout, Spanish
Hazelden Betty Ford Foundation: Why Is Meth So Addictive?, YouTube 12:08
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