"It's Not a One-Size-Fits-All": Patient Perspectives on Contingency Management and Community Reinforcement Approach for Methamphetamine Use Disorder in Permanent Supportive Housing

Background. Methamphetamine use is a growing concern, particularly among individuals experiencing homelessness or living in permanent supportive housing (PSH). While evidence-based treatments such as contingency management (CM) and the community reinforcement approach (CRA) exist, little is known about their implementation and adaptation in PSH. Methods. Semi-structured interviews were conducted with 25 PSH residents using methamphetamine in Seattle, Washington (May–July 2022). Thematic analysis using the Consolidated Framework for Implementation Research identified barriers, facilitators, and adaptations for CM and CRA. Results. Residents expressed interest in CM and CRA, citing knowledge/beliefs about the interventions, implementation climate, and tension for change as facilitators. Barriers included resource availability and staff capacity. Residents suggested adapting CM by incentivizing diverse behaviors and tailoring CRA to prioritize recreational and social activities. Conclusions. Adapting CM and CRA in PSH could address needs of residents using methamphetamine but addressing social determinants and resource limitations is crucial.