Contingency management interventions for substance use and addictive behaviours: review of the United Kingdom evidence base

Background and aims
Substance use and other addictive behaviours including gambling remain major public health concerns in the UK. Despite the effectiveness of substance use treatment approaches, treatment adherence and success rates remain low. Contingency Management (CM), a behavioural intervention using positive reinforcement, is a promising approach to enhance clinical outcomes; however, its implementation in UK settings remains limited. This scoping review aimed to explore how CM has been adopted to improve outcomes for substance use and addictive behaviours in the UK, addressing the gap between international evidence and UK-specific healthcare needs.

Methods
A systematic search of databases (Embase, MEDLINE, PsycArticles and PsycInfo) for UK-based CM studies published before March 2025 was undertaken. The review adhered to PRISMA-ScR guidelines, and the protocol was prospectively registered on the Open Science Framework. Eligible studies were peer-reviewed, full-text articles, reporting the exploration of CM interventions to improve outcomes for substance use and other addictive behaviours within UK settings. Screening and data extraction were independently conducted using Covidence. A narrative synthesis explored study outcomes including effectiveness, feasibility and acceptability. Using the Context and Implementation of Complex Interventions (CICI) framework, key contextual factors influencing CM implementation in the UK across setting, socio-cultural, political and ethical domains were explored.

Results
A total of 208 articles were identified, with 36 full texts reviewed and 29 eligible for inclusion. Nine studies assessed effectiveness, six included economic evaluations, six assessed feasibility and 14 assessed acceptability. Clinical effectiveness was supported in most studies, particularly for promoting abstinence and medication adherence. Feasibility concerns included resource limitations, training and recruitment challenges. CM was generally well-accepted by service users and professionals, and digital approaches showed promise with high adherence and accuracy. Barriers and facilitators to CM implementation operating at micro, meso and macro levels are presented.

Conclusion
This scoping review of studies implementing Contingency Management (CM) in UK addiction treatment highlights several barriers to CM adoption, including resource limitations, concerns about its impact on therapeutic relationships and ethical issues regarding manipulation and fairness. It also points to the need for adapting CM protocols to fit UK treatment philosophies, particularly aligning with harm reduction approaches. CM's success depends on multi-level support, including policy, training and integration with existing systems. Recommendations include strengthening research on CM's long-term impact, ensuring fidelity to core principles, and investing in digital tools to reduce administrative burden.

© 2025 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

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