Before leaving office, the Biden administration increased the annual cap for Medicaid-reimbursed contingency management (an evidence-based psychosocial intervention) as part of an individual’s addiction treatment. This move demonstrates what I have seen in my own practice: Contingency management drives results when it comes to treating substance use disorder.
Despite the evidence and fact that every individual living with substance use disorder (SUD) requires a unique approach to treatment for it to be successful, we have continued to rely on the same practices, such as cognitive behavioral therapy (CBT) and motivation to change, expecting them to result in long-term recovery for all.
We cannot continue those same patterns when more than 48 million Americans have battled an SUD in the past year, and the relapse rate is between 40 percent and 60 percent. Those numbers are even more staggering when we look at individuals in the criminal justice system, where an estimated 63 percent of people in jail and 58 percent in prison have a substance use disorder. There is no better time than now to start using more innovative and evidence-based approaches to treating SUD, like solution-focused therapy and contingency management.
The role of contingency management in addressing America’s drug epidemic
The concept of contingency management is familiar to all of us. As a child, your parents may have given you an allowance to make your bed or do your chores. Or you may have gotten an ice cream treat if you got above Bs on your report card.
Contingency management, sometimes called voucher-based reinforcement therapy, is based on the principles of positive reinforcement and grounded in behavioral psychology. It’s the concept of “rewarding” positive behaviors, thus increasing the likelihood of repetition. By receiving a reward for doing a desirable behavior (like making your bed), we leverage the brain’s reward system by utilizing dopamine to encourage change and repetition.
Contingency management, while effective for anyone, is particularly effective for individuals living with addiction or SUD. It’s effective because it provides an immediate incentive, reinforces positive choices, and is based upon clear and achievable goals.
For example, one of our clients, Jamie (name changed), was referred to us for health care and treatment services after getting arrested for using drugs. Initially, she didn’t like meeting with her care team or talking to anyone about her problems. However, each time she met with us or completed her daily therapeutic lessons on our app, she received a small cash reward. While she didn’t start our program fully on board, these rewards motivated her to stay engaged. After a couple of months, she opened up to her provider about how she looked forward to her daily lessons and meeting with her team. Not only did she earn cash, but she also realized these check-ins and appointments made her feel purposeful, healthy, and on track to reach her goals.
While the efficacy of contingency management is true in my practice, it’s also been widely researched and proven effective for treating substance use disorders. Analyses of contingency management consistently demonstrate greater treatment outcomes. Whether cocaine or alcohol, the results are undeniably positive.
In practice: How contingency management is deployed effectively
Contingency management can be integrated into SUD treatment to encourage engagement, increase motivation, and bolster recovery. While contingency management can be used in any treatment setting, one of its benefits is that it can be an “add-on” for providers who don’t directly treat substance use disorder because they can partner with companies that offer app-based rewards and digital incentive programs.
These contingency management platforms allow providers to reinforce positive behaviors–like attending appointments, engaging in therapy, or adhering to medications or treatment plans–without having to manage the incentive structure themselves.
To properly deploy contingency management, we need to start by identifying the patient’s health-related goals—including specific changes required to improve health outcomes—and then determine the best platform that automates incentives and tracks engagement. Consider digital applications like Noom or other fitness apps for weight loss and Holon Health for engagement in mental health, addiction recovery, and primary care follow-up. It’s easy to embed reward-based strategies into chronic disease management, mental health treatment, and wellness programs when both the provider and patient are aligned on specific goals and the reward attainment is clear. Plus, partnering with companies that can automate contingency management reduces the burden on providers and allows them to scale, boosting patient outcomes.
Reframing SUD treatment for the future: a shift in perspective
The future of SUD treatment must go beyond traditional models and fully embrace innovation, technology, artificial intelligence, and personalized care. Rather than focusing on punitive approaches or standardized treatments that fail to account for individual differences, the next phase of treatment should prioritize customization and engagement.
Positive psychology plays a crucial role in this shift, helping to reduce the negative experiences often associated with recovery. When individuals feel empowered, supported, and motivated, they are more likely to stay engaged in treatment and maintain long-term recovery. As patients in any health care setting, it is time that we captain our own ship.
Technology is at the center of this transformation. AI-powered treatment plans can analyze an individual’s history, behavioral patterns, and even genetic predispositions to develop tailored interventions that evolve with their progress. Digital tools like app-based contingency management programs offer immediate, tangible rewards for positive behaviors, reinforcing engagement and adherence in ways that feel motivating rather than obligatory. Wearable biosensors could further enhance care by tracking real-time physiological markers of stress or cravings, allowing for just-in-time interventions that prevent relapse before it happens, truly meeting patients where they are at with immediacy. AI chatbots and virtual therapy assistants provide an additional layer of support, offering simple techniques, mindfulness guidance, and motivational encouragement 24/7. Digital therapeutics are also emerging as structured, evidence-based ways to deliver behavioral therapy remotely, making treatment more accessible.
The treatment toolbox itself must also expand to include emerging pharmacological and holistic approaches. GLP-1 receptor agonists, originally developed for diabetes and weight management, are now being explored for their potential to reduce cravings and compulsive behaviors in addiction treatment. Psychedelic-assisted therapy with substances like ketamine, psilocybin, and MDMA is showing promise in rewiring reward circuits and enhancing emotional processing, offering new hope for individuals struggling with treatment-resistant SUD. Additionally, neuromodulation techniques such as transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) are being studied for their ability to regulate cravings and withdrawal symptoms by directly influencing brain activity.
Beyond pharmaceuticals, alternative treatments such as peptides, adaptogens, and gut-brain axis interventions could play a supportive role in recovery. Peptides like BPC-157 (body protection compound) and Semax have potential neuroprotective and stress-regulating benefits, while NAD+ therapy may aid in cellular repair and neuroprotection for individuals recovering from chronic substance use. While not in recovery myself, I use peptides such as BPC and NAD+ among other bioregulators to support my own health and wellness. Supplements that support gut health, such as probiotics and anti-inflammatory compounds, are gaining attention as the gut-brain connection becomes more recognized in addiction science. Holistic therapies like EMDR, breathwork, neurofeedback, and somatic therapy further offer valuable tools for addressing trauma, emotional regulation, and nervous system imbalances that contribute to substance use patterns.
Failing to incorporate these advancements into mainstream SUD treatment could have serious consequences. Traditional methods with high dropout and relapse rates will continue to fail many individuals, reinforcing a cycle of addiction that could be interrupted by more innovative approaches. Treatment programs that do not embrace positive psychology, personalization, and technology-driven solutions risk alienating patients by creating rigid, punitive, or negative experience-heavy interventions. If the U.S. health care system does not consider these emerging options, disparities in access will grow, leaving only those with financial means able to benefit from modern, effective treatments. The outdated one-size-fits-all approach will not meet the needs of diverse populations, particularly those in underfunded or underserved communities.
The future of substance use disorder treatment must be dynamic, patient-centered, and technology-enhanced. Recovery should be framed as an evolving, individualized process where innovation continuously improves outcomes and accessibility. Integrating AI, digital therapeutics, and new pharmacological options alongside positive psychology and holistic interventions will create a system where more individuals can achieve lasting recovery. Moving forward, the question is not whether we should explore these options but how quickly we can implement them to change lives.
Traci Sweet is a health care executive.