{"doi":"10.1111/add.16534","title":"Contingency management as a maintenance intervention in the long‐term treatment of substance use disorders","abstract":null,"journal":"Addiction","year":2024,"id":671006,"datarank":0.4894437151637683,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.19755719280547124,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.19755719280547124,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":3,"citers_with_citation_signal":2,"citers_with_endowment":2,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":769546,"name":"Cory Toegel","orcid":"0000-0002-9050-8398","position":1,"is_corresponding":false},{"id":384778,"name":"Kenneth Silverman","orcid":"0000-0003-2724-1413","position":2,"is_corresponding":false},{"id":384775,"name":"Forrest Toegel","orcid":"0000-0003-4644-5788","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Contingency management as a maintenance intervention in the long‐term treatment of substance use disorders","abstract":"Contingency management procedures that incentivize drug abstinence have been remarkably effective in promoting drug abstinence; however, as with other chronic health problems, treatment effects dissipate when interventions are removed. Researchers and policymakers should consider using contingency management as a long-term maintenance procedure to retain treatment effects and prevent relapse indefinitely. Contingency management procedures that provide incentives for evidence of recent drug abstinence are remarkably effective in the treatment of stimulant use disorder, but are not used widely in society. Khazanov et al. [1] suggested two types of very reasonable steps to promote more widespread use of these interventions: (a) change contingency management interventions themselves (e.g. change parameters of the reinforcement schedule); and (b) change policies and practices of the treatment system (e.g. offer incentives to providers for using contingency management interventions). The proposed changes could improve society's treatment of stimulant use disorder and reduce the broad and debilitating problems associated with stimulant use. Although the proposals are reasonable, we would like to make one suggestion that could be critical to improving the effectiveness, acceptance, and widespread dissemination of contingency management interventions: the use of contingency management as a maintenance intervention to promote long-term drug abstinence. Substance use disorders are chronic and relapsing problems that, like other chronic illnesses, require long-term treatment [2]. As with other substance use disorder treatments, contingency management procedures that incentivize abstinence do not reliably promote abstinence that persists after abstinence incentives are discontinued [3]. To enhance the long-term outcomes of contingency management interventions, Khazanov et al. [1] suggest that patients be allowed to re-engage in contingency management interventions, that the typical duration of treatment increase from 12 to 24 weeks, and that contingency management intervention be tapered at the end of treatment instead of being terminated abruptly. Although these suggestions are reasonable and potentially effective for some patients, we suggest that long-term maintenance of abstinence incentives may be required for many patients [4]. The treatment of chronic conditions frequently must be maintained to retain treatment effects. The treatment of opioid use disorder by methadone treatment is a good example. Methadone is one of the most effective treatments for opioid use disorder, but it must be maintained to maintain effectiveness [5]. Although few studies have arranged long-term exposure to contingency management interventions, we know that cocaine abstinence can be maintained by maintaining abstinence incentives [6-10]. As with other substance use disorder treatments, many patients relapse when abstinence incentives are discontinued, even after abstinence incentives are maintained for a long time [6, 11, 12]. A study conducted by DeFulio et al. [7, 11] provides a good illustration. After a 6-month abstinence initiation period, participants in this study provided routine urine samples and were invited to work in a model workplace for 1 year where they could earn an hourly wage for working. During that year, participants were randomly assigned to receive incentives that depended on employment alone (employment only) or employment and cocaine abstinence (abstinence-contingent employment). Employment only participants could work and earn hourly wages ($8 per hour) independent of urinalysis results. Abstinence-contingent employment participants had to provide cocaine-negative urine samples to maintain the highest hourly wage ($8 per hour). Abstinence-contingent employment participants provided significantly more cocaine-negative urine samples during the year of that study than employment only participants [7]. That study showed that contingency management procedures that incentivize cocaine abstinence can maintain abstinence over a long period (1 year). To evaluate post-intervention effects, both groups were monitored in a 1-year follow-up period during which neither group earned incentives for cocaine-negative urine samples. During that follow-up year, many abstinence-contingent employment participants relapsed, and the two groups provided similar rates of cocaine-negative urine samples [11]. This study showed that long-term incentives can maintain cocaine abstinence, but many people relapse when the incentives are discontinued. Using abstinence incentives as a long-term maintenance intervention could be an effective way to prevent relapse and sustain long-term abstinence [4]. The long-term maintenance of contingency management interventions has implications for society and for individual patients. For society, long-term maintenance of contingency management interventions is costly, much like the costs of maintaining methadone for opioid use disorder or antiretroviral medication for HIV. However, failing to acknowledge and address the chronic, relapsing nature of drug use disorders (including stimulant use disorders) risks dismissal of contingency management interventions as ineffective, which could lead to the further resistance to their widespread adoption. For individual patients, short-term exposure to abstinence incentives will not have lasting or lifelong effects for many patients. For these people, achieving lasting, lifelong abstinence may require maintenance of abstinence incentives. Forrest Toegel: Conceptualization; writing—original draft; writing—review and editing. Cory Toegel: Conceptualization; writing—original draft; writing—review and editing. Kenneth Silverman: Conceptualization; writing—original draft; writing—review and editing. None. The authors declare no conflicts of interest.","is_dataset_classified":null,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"38752281","pmcid":"PMC11966840","openalex_id":"https://openalex.org/W4396967028","authors":[],"funders":[{"funder_name":"NIDA NIH HHS","grant_id":"R01 DA053218","title":null}],"total_grants":1,"fwci":1.6971,"citation_percentile":0.84437271,"influential_citations":0,"citation_trend":[{"year":2024,"count":1},{"year":2025,"count":3},{"year":2026,"count":2}],"oa_status":"bronze","license":"http://onlinelibrary.wiley.com/termsAndConditions#vor","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/add.16534","host_type":"journal"},{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/add.16534","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/add.16534","host_type":"publisher"},{"url":"https://doi.org/10.1111/add.16534","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/38752281","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11966840","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC11966840/pdf/nihms-2069778.pdf","host_type":"repository"}],"fields_of_study":["Substance Abuse Treatment and Outcomes","Opioid Use Disorder Treatment","Prenatal Substance Exposure Effects","Humans","Substance-Related Disorders","Behavior Therapy"],"mesh_terms":["Behavior Therapy","Humans","Substance-Related Disorders"],"keywords":["Contingency management","Abstinence","Psychological intervention","Incentive","Intervention (counseling)","Medicine","Contingency","Psychiatry","Psychology","Intensive care medicine","Drug Addiction","Substance Use Disorders","Relapse Prevention","Stimulant Use Disorder","Maintenance Intervention"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-16T00:58:24.621724Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}