While many studies have shown that contingency management (CM)—i.e., the use of motivational incentives—can help reduce drug use, widespread adoption of CM has been slow, due at least in part to concerns about cost. This observational study measured the effect of low-cost CM on urine drug tests and attendance at partial-hospitalization and intensive-outpatient treatment programs for adolescents aged 12–18. Patients with perfect attendance and negative urine tests earned chances to draw prizes of varying value ($0–$15). The number of draws increased with each consecutive negative urine test. Researchers compared patients treated in the 3 months before CM was introduced (n=83) with those treated after (n=264).

• The proportion of positive urine tests for any drug decreased significantly (from 33% to 23%) after CM.
• Patients treated with CM had significantly fewer positive urine tests for opioids and cocaine and fewer (though not significantly) positive urine tests for marijuana, benzodiazepines, and amphetamines.
• Attendance did not improve with CM, but length of stay increased from 13 to 15 days.
• Total cost of the 12-month CM program was $1524.58, or $0.39 per patient per day. This cost was more than offset by billed charges for clinical services, which increased substantially due to the greater length of stay.

Comments by Michael Levy, PhD
These results demonstrate that adolescent substance users who attend a treatment program may benefit from very low-cost CM. Programs that work with adolescents should consider implementing low-cost CM to improve outcomes since it appears not to add a substantial financial burden. In some cases, CM may even reduce overall program costs.