If Abstinence Isn’t the Point of Contingency Management, What Is?

Contingency management (CM) is a leading treatment for stimulant use disorder (SUD) based on positive reinforcement through urine drug screens. Some programs are critiqued for being infantilizing and promoting abstinence only. There's a call for modifying CM for harm reduction, proposing changes like easier access to tests and not penalizing relapse. Challenges to widespread implementation include funding limitations and bureaucratic hurdles. A harm reduction CM could focus on appointment retention, transportation support, education on safer use, and individualized goal-setting. However, incentivizing multiple behaviors may complicate CM efficacy.