Operationalizing Contingency Management to Improve Adherence and Retention in Methadone Treatment: A Scoping Review

BACKGROUND: Contingency management, an evidence-based intervention, can be used to reinforce adherence and retention in methadone treatment. A literature synthesis on the delivery of contingency management for this purpose will facilitate the adoption of this intervention. Our scoping review addressed three questions: (1) What behaviors does contingency management target to promote adherence and retention in methadone treatment? (2) What incentives are used to reinforce these behaviors? and (3) What are the operational aspects of contingency management implementation in methadone treatment? METHODS: We searched original research articles in English in MEDLINE/PubMed and Embase. We summarized findings and identified research gaps through narrative analysis of the selected studies. RESULTS: We identified 14 articles reporting 16 studies. Most studies were conducted in the United States and in large cities. Daily methadone consumption, attendance to scheduled appointments, and completion of individually tailored tasks were the target behaviors to promote adherence and retention. Contingency management was implemented in voucher-based and prize-based formats with high flexibility in adjusting the definition of a behavior achievement, value, and types of incentives to fit within clinical and budget constraints. Two highlighted aspects of contingency management delivery were how to identify the most appropriate and motivational incentives to a particular population and how to communicate with participants before and during the intervention. CONCLUSION: Contingency management is highly adaptable to different settings to improve treatment adherence and retention in methadone programs.