National Survey of the Implementation of Contingency Management in Drug and Alcohol Treatment Services in England
Background: Evidence-based interventions (EBIs) exist to treat problematic D&A use however their implementation is often slow and complex, affecting the quality of treatments offered to service users. One effective intervention which has a strong evidence-base and is recommended in multiple clinical guidelines is Contingency Management (CM). CM involves providing a ‘reward’ (in the form of vouchers and verbal praise) to reinforce behaviours which align with personal recovery (e.g. attending an appointment, medication adherence and abstinence). The overall aims of the PhD are to assess how CM programmes have been adapted, translated and implemented into routine clinical practice in D&A treatment services in England, and to explore the factors that promote or hinder implementation. Findings from the first phase of the PhD, a national survey of D&A treatment providers will be presented.
Methods: The PhD utilises theories and frameworks from the field of Implementation Science (specifically the Context and Implementation of Complex Interventions framework) and uses a multi-level, mixed-method research design. During the first phase of the study an online survey was distributed to all adult D&A treatment providers in January 2024. The survey population was identified from the National Drug Treatment Monitoring System (NDTMS) which treatment providers report to monthly. Service managers emails were accessed directly from the providers and invitation emails including a survey link were sent directly to managers. Data was collected on (a) the number of services using CM, (b) the characteristics of the CM programmes being implemented and (c) service manager opinions regarding the utility of CM.
Results: 330 adult D&A treatment providers were identified on the NDTMS and service managers emails were obtained directly from the providers. Findings will be presented describing the rates of CM implementation in England, the behaviour(s) being targeted; eligibility criteria, how the target behaviour is reinforced, service managers opinions regarding the utility and ethical status of CM and the perceive barriers and facilitators to the successful implementation of CM.
Conclusions: This study will provide an updated national picture of the implementation of CM in England. The PhD will generate evidence which supports enhanced real-world implementation strategies. This will advance the application of Implementation Science in the Addictions. Findings will inform future implementation research on how to increase the uptake of EBIs in the Addictions and optimise the implementation process, providing the basis for further work designed to affect positive change in service delivery, workforce development and the quality of treatments offered to people experiencing addiction.
