Last year, California was the first state to receive approval from the Biden administration to include sobriety payments in Medicaid, helping pave the way for contingency management (CM) programs for people with stimulant use disorder. The program was piloted as part of an extensive healthcare initiative led by Democratic Governor Gavin Newsom. This initiative aims to offer various behavioral health and social services to California’s most vulnerable residents, people with addictions, disabilities, and mental health issues – often people who live with a combination of all three. (Washington State and Montana have since adopted similar programs.)

What is Contingency Management?

Contingency management is a behavioral therapy used in drug treatment that involves providing tangible rewards to reinforce positive behaviors. In addiction recovery, it’s for abstinence from drug use.

The core idea is to incentivize recovery by offering immediate, positive reinforcement when patients meet specific treatment goals. These goals may be as simple as passing a drug test or attending therapy sessions. This approach is based on the principles of “operant conditioning,” a behavioral therapy based on the idea that behaviors are strengthened or weakened by their consequences.

Contingency management is backed by research showing that people with hardcore addictions and other struggles can respond to positive reinforcements and rewards.

How Does California’s Contingency Management Program Work?

In California, the focus is on stimulant drugs like cocaine and methamphetamine. Participants are required to provide regular drug tests, and if the tests show no trace of stimulants, they receive a gift card as a reward, starting at $10 for the initial test. The payment increases with continued abstinence, reaching up to $599 annually.

To date, approximately 2,700 stimulant users across 19 of California’s 58 counties have enrolled in the contingency management program.

Los Angeles County, the most populated county in the United States, has seen the highest participation rate. Public health officials there have highlighted contingency management as one of the few effective methods for reducing stimulant use.

Participants face no penalties for failing a drug test. Instead, they forgo the payment for that day but are encouraged to continue participating and can try again in the future. The program’s emphasis on positive reinforcement rather than punishment supports long-term recovery and resilience against relapse.

Looking Forward to Hope

CM has been shown to significantly reduce methamphetamine use, with studies indicating higher rates of abstinence compared to standard treatment on its own. The motivation is helpful for people who have struggled with addiction to “earn” a reward for their sobriety. Patients engaged in CM programs are more likely to stay in treatment longer, which is critical for long-term recovery. They often also experience improvements in other areas, such as mental health, social functioning, and overall quality of life.

Treating stimulant use disorder can be exceptionally challenging due to its profound effects on the brain’s reward system, intense withdrawal symptoms, and persistent cravings. People in withdrawal also sometimes experience cognitive impairments that hinder effective therapy engagement. Social isolation and high rates of co-occurring mental health disorders can further complicate treatment. Contingency management shows promise in helping people with this disorder get the help they need and stay motivated.