Evolution of the substance use landscape: Implications for contingency management
Drug potency is up, so CM needs smaller, faster incentives and multi-drug targets to stay effective.
01Research in Context
What this study did
Goodwin et al. (2025) wrote a narrative review about contingency management for substance use.
They looked at how street drugs have changed. Potency is higher. People mix drugs more often.
The team asked: how should CM change to keep working in this new landscape?
What they found
Stronger, mixed drugs mean old CM plans may fail.
The review says to give smaller, faster incentives and test for many drugs at once.
How this fits with other research
Davidson et al. (2025) show CM still works well for single drugs like cocaine. Goodwin says today we need to target more than one drug at a time.
Toegel et al. (2020) already proved that switching drug targets every two weeks can boost abstinence for both opiates and cocaine. This supports Goodwin’s call for polysubstance panels.
Garner et al. (2025) tried paying staff, not clients, to improve care. Goodwin’s review opens the door for new staff-side tweaks as well.
Why it matters
If you run CM in a clinic, update your plan now. Test urine for several drugs, not just one. Drop the value of each voucher but deliver it right after the clean test. These small shifts match the current street supply and can keep clients engaged and abstinent.
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02At a glance
03Original abstract
Contingency management (CM), which involves the delivery of incentives upon meeting behavioral goals, has the potential to improve substance use treatment outcomes. The intervention allows for flexibility through numerous modifiable components including changes to incentive magnitude and schedule, target behavior, and intervention structure. Unfortunately, numerous changes in the substance use landscape have occurred in the past 10 to 15 years: Substances are more potent, overdose risk has increased, new substances and methods of use have been introduced, and substance classes are increasingly being intentionally and unintentionally mixed. These developments potentially undermine CM outcomes. We explored recent substance use changes due to legislative, regulatory, social, and economic factors for four substance classes: stimulants, opioids, tobacco, and cannabis. We discuss potential adjustments to the modifiable components of CM for future research in response to these changes. By continually adapting to the shifting substance use landscape, CM can maintain optimal efficacy.
Journal of Applied Behavior Analysis, 2025 · doi:10.1002/jaba.2911