Real‐World Implementation of Contingency Management and Benefits of a Controlled Environment “Head Start”

To use quality improvement (QI) principles to implement contingency management (CM) in an outpatient clinic. Prize-based CM was implemented for stimulant use disorder using standard protocols with QI processes used to improve efficiency and effectiveness. CM was successfully implemented in an outpatient addictions clinic using clinical funds. Participants who were discharged to the outpatient clinic from a controlled environment (such as hospital, withdrawal management, residential treatment program) had 8.3 (SD = 3.1) weeks of consecutive abstinence (CA) and 10.7 (SD = 1.0) weeks total abstinence. Pragmatic clinical implementation of CM yielded results that are comparable to controlled trials in similar populations. QI processes identified that a controlled environment resulted in significant ongoing abstinence.CM was implemented in a small community clinic with no additional funding, and QI principles were used to improve efficiency and effectiveness. The initial implementation of 17 participants yielded a mean of 2.2 (SD = 3.2) weeks of CA. Recent discharge from a controlled environment resulted in 8.3 (3.1) weeks CA.