Tricia McQuarrie is a PhD researcher at Middlesex University’s Drug and Alcohol Research Centre, funded by the Society for the Study of Addiction. Her research explores how Contingency Management is interpreted, adapted and implemented in drug and alcohol treatment services in England, drawing on a national survey and qualitative case studies. She is particularly interested in how service-user needs, workforce perspectives, organisational conditions and commissioning shape the implementation of evidence-based interventions. Tricia has a background in psychology, addiction studies and frontline addiction and homelessness services. She also works as a Research Assistant at Middlesex University on an NIHR-funded evaluation of drugs education.

Abstract

Implementing contingency management in England: A case study investigation

Aims: Contingency management is an adjunctive behavioural intervention which involves systematic application of positive reinforcement to encourage behaviour change. Contingency management is evidenced-based and recommended in clinical guidelines. However, it’s unclear whether and how drug and alcohol services in England are implementing contingency management. The study aimed to find out how many services use contingency management (and in what form), and to investigate factors influencing its implementation.

Methods: A phased, mixed methods implementation study utilised a determinant implementation science framework: the Context and Implementation of Complex Interventions framework.

Phase one: National survey of treatment providers.

Phase two: Case studies in six sites where contingency management was implemented to target different recovery related behaviours. Interviews and focus groups were conducted to understand the implementation process and identify challenges and opportunities for scale-up.

Results: The survey identified services implementing contingency management to target the uptake of physical health interventions, attendance, prosocial behaviours and multiple targets. Findings from the case study data highlight a range of contextual factors impacting implementation and limited adherence to the evidenced-based model. Recommendations for services will be outlined to guide services how best to design and implement contingency management with fidelity whilst taking into consideration contextual factors.

Conclusions: This research identified a range of factors impacting the successful implementation of contingency management in England. This is essential evidence not only for implementing contingency management but for designing further implementation studies to increase the uptake of evidence-based interventions in drug and alcohol services.