(67) Impact of Contingency Management on Retention in Outpatient SUD Programs

Background & Introduction: Although overdose deaths in Los Angeles County have declined in recent years, stimulant-involved deaths continue to rise. The proportion of overdose deaths involving stimulants increased from 60% in 2015 to 75% in 2024, with methamphetamine involvement rising from 42% to 62% over the same period, surpassing both opioids (57%) and fentanyl (52%) in 2024. This trend likely reflects the success of opioid-focused prevention strategies, contrasted with the limited availability of effective interventions for stimulant use disorders (StUD). One evidence-based approach to StUD is contingency management (CM), which uses positive reinforcement to support reductions in drug use. Through California Advancing and Innovating Medi-Cal (CalAIM), eligible Medi-Cal patients with StUD can earn up to $599 in gift cards for negative urine drug tests. Participants who received CM have been linked to higher rates of abstinence, improved treatment retention, and better long-term recovery. Specifically for StUD, CM combined with another behavioral treatment is more effective at promoting abstinence than standalone treatments. Despite these benefits, CM implementation for StUD remains limited.
We hypothesize that patients with a StUD receiving CM at Tarzana Treatment Centers (TTC) will exhibit better retention compared to those not receiving CM.

Methods: A retrospective cohort study was utilized to examine the impact of CM enrollment on retention among patients with StUD in an outpatient SUD treatment program (ASAM 1.0 and 2.1) at TTC. Data were compiled from TTC’s electronic health record system, myAvatar NX, for patients during fiscal year 2024/2025 (N = 1,243). The primary outcome was retention, measured using length of stay (LOS) and program discharge status. Only patients who discharged were included in this analysis – categorized by completing treatment or leaving against medical advice (AMA). A t-test assessed the impact of CM enrollment on LOS, followed by a linear regression analysis to examine whether CM significantly predicted LOS. A logistic regression analysis was also conducted to determine whether CM significantly predicted discharge status. Statistical significance was set to p < 0.05.

Results: Patients with StUD participating in CM demonstrated a substantially longer average LOS of 101 days compared to those not enrolled in CM with average LOS of 68 days. A t-test was conducted and confirmed that the relationship between CM enrollment and LOS was statistically significant (p < 0.05) and linear regression results indicated that participation in CM was associated with a significantly longer LOS compared to non-CM patients (p < 0.05). Treatment completion rates were higher among CM participants, with 55% discharging as treatment complete versus 19% among non-participants and an AMA rate of 20% compared to 46%. Logistic regression analysis showed that patients in CM were significantly more likely to complete treatment, whereas patients not in CM were more likely to discharge AMA (p < 0.05).

Conclusion & Discussion: Participation in TTC’s CM program is associated with better retention for patients with StUD. Individuals enrolled in CM demonstrated substantially longer lengths of stay and were more likely to complete treatment compared to those not enrolled. These patterns indicate that CM may help improve engagement, promote continued participation, and support successful discharge from care. However, because participation in CM was self-selected and not adjusted for in the analysis, observed differences may partially reflect underlying motivation or stability rather than the effect of CM itself, limiting causal inference. Future analyses should account for this self-selection and examine additional factors – such as demographic characteristics, frequency of engagement, and co-occurring diagnoses – to more accurately assess the independent impact of CM across patient groups.

References:

1. Ginley, M. K., Pfund, R. A., Rash, C. J., & Zajac, K. (2021). Long-term efficacy of contingency management treatment based on objective indicators of abstinence from illicit substance use up to 1 year following treatment: A meta-analysis. Journal of Consulting and Clinical Psychology, 89(1), 58.

2. Los Angeles County Department of Public Health, Substance Abuse Prevention and Control. (2025, October). Data Report: Drug Overdoses in Los Angeles County. https://publichealth.lacounty.gov/sapc/MDU/SpecialReport/Report-on-Drug-Overdoses-in-Los-Angeles-County.pdf.

3. Parent, S. C., Peavy, K. M., Tyutyunnyk, D., Hirchak, K. A., Nauts, T., Dura, A., ... & McDonell, M. G. (2023). Lessons learned from statewide contingency management rollouts addressing stimulant use in the Northwestern United States. Preventive medicine, 176, 107614.

4. Pfund, R. A., Ginley, M. K., Rash, C. J., & Zajac, K. (2022). Contingency management for treatment attendance: a meta-analysis. Journal of Substance Abuse Treatment, 133, 108556.