Evaluation of a Contingency Management Intervention to Treat Substance Use Disorders in a Family Medicine Residency Program: A Retrospective Observational Review Study of Patient Outcomes and Experiences.
- 1iREACH Research Institute, Christiana Care Health System.
- 2Department of Family and Community Medicine, Christiana Care Health System.
Abstract
Objective
Contingency management (CM) is an evidence-based behavioral intervention using positive reinforcement to achieve a treatment goal. Despite effectiveness in treating those with substance use disorders (SUDs), CM is underutilized in clinical practice. This study describes the development of a CM intervention in a family medicine residency program SUD treatment program and evaluates patient retention and experiences.Methods
This retrospective observational pilot study focused on patients receiving treatment for SUD and CM services at two Delaware family medicine clinics between August 2023 and June 2024. Participants earned points for visit attendance and urine drug screens meeting treatment goals. Points were redeemed using a two-tiered fishbowl system. Outcomes included patient retention at 3 and 6 months. Patient experiences were assessed using a mixed-methods survey administered between March and August of 2025.Results
Forty-seven patients received CM services. Median participation was 9 months (IQR, 5-10). SUD treatment retention was 93.6% (3 months) and 78.7% (6 months). Retention for ≥6 months differed significantly between participants treated for opioid use disorder (OUD) and other SUDs (p=0.04). Participants earned a median of 8 points (IQR, 5-12), representing approximately 80% of the median number of points possible. Over half of participants (54.8%, 23/42) completed the survey. Overall, respondents reported positive experiences with CM. Thematic analysis of open-ended survey items further contextualized these findings with descriptive participant feedback.Conclusions
CM implementation in a family medicine residency SUD treatment program was feasible and associated with high retention rates. Findings highlight the value of automated documentation, appropriate workflows, and adequate participant incentives. Larger prospective studies with longer follow-up periods are needed to assess effectiveness and sustainability.Policy implications
CM represents a patient-centered alternative to a historically punitive approaches to SUD care by focusing on positive reinforcement, promoting equitable treatment access, and encouraging affirming interactions between patients and providers.
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BibTeX
@article{williams2026evaluation,
title = {{Evaluation of a Contingency Management Intervention to Treat Substance Use Disorders in a Family Medicine Residency Program: A Retrospective Observational Review Study of Patient Outcomes and Experiences.}},
author = {Kimberly D Williams and Deanna Gorgei and Kendall McDowell and Jordan Jacobs and James M LaRosa},
journal = {Delaware journal of public health},
year = {2026},
month = oct,
doi = {10.32481/djph.2026.10.09},
url = {https://europepmc.org/article/MED/42948813},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Evaluation of a Contingency Management Intervention to Treat Substance Use Disorders in a Family Medicine Residency Program: A Retrospective Observational Review Study of Patient Outcomes and Experiences.
AU - Kimberly D Williams
AU - Deanna Gorgei
AU - Kendall McDowell
AU - Jordan Jacobs
AU - James M LaRosa
PY - 2026
DA - 2026/10/26
JO - Delaware journal of public health
DO - 10.32481/djph.2026.10.09
UR - https://europepmc.org/article/MED/42948813
AB - Objective Contingency management (CM) is an evidence-based behavioral intervention using positive reinforcement to achieve a treatment goal. Despite effectiveness in treating those with substance use disorders (SUDs), CM is underutilized in clinical practice. This study describes the development of a CM intervention in a family medicine residency program SUD treatment program and evaluates patient retention and experiences.Methods This retrospective observational pilot study focused on patients receiving treatment for SUD and CM services at two Delaware family medicine clinics between August 2023 and June 2024. Participants earned points for visit attendance and urine drug screens meeting treatment goals. Points were redeemed using a two-tiered fishbowl system. Outcomes included patient retention at 3 and 6 months. Patient experiences were assessed using a mixed-methods survey administered between March and August of 2025.Results Forty-seven patients received CM services. Median participation was 9 months (IQR, 5-10). SUD treatment retention was 93.6% (3 months) and 78.7% (6 months). Retention for ≥6 months differed significantly between participants treated for opioid use disorder (OUD) and other SUDs (p=0.04). Participants earned a median of 8 points (IQR, 5-12), representing approximately 80% of the median number of points possible. Over half of participants (54.8%, 23/42) completed the survey. Overall, respondents reported positive experiences with CM. Thematic analysis of open-ended survey items further contextualized these findings with descriptive participant feedback.Conclusions CM implementation in a family medicine residency SUD treatment program was feasible and associated with high retention rates. Findings highlight the value of automated documentation, appropriate workflows, and adequate participant incentives. Larger prospective studies with longer follow-up periods are needed to assess effectiveness and sustainability.Policy implications CM represents a patient-centered alternative to a historically punitive approaches to SUD care by focusing on positive reinforcement, promoting equitable treatment access, and encouraging affirming interactions between patients and providers.
SN - 2639-6378
ER -