Perceptions of Contingency Management for Addiction Clinic Linkage Among Hospitalized Patients with Alcohol Use Disorder: Initial Findings of a Randomized Controlled Trial

Background: Post-discharge follow-up is rare among patients with alcohol use disorder (AUD), estimated at 12% at our institution (pre-pandemic). Contingency management (CM) – providing a concrete/financial incentive to elicit a behavioral outcome– may increase alcohol abstinence (Koffarnus, Bickel, and Kablinger 2018; McDonell et al. 2017). We explored the use of CM in promoting linkage among hospitalized patients with AUD. This will provide insight to determine whether CM is a viable tool for increasing follow-up among patients admitted with AUD.

Methods: This study occurs within a pilot trial (target n=45-60) that randomizes patients to receive extended-release naltrexone, intravenous ketamine, or neither prior to discharge. All participants receive enhanced linkage to care, including a payment of $10 at enrollment and $20 at an addiction clinic one week post-discharge. We present data on participant perception of how financial motivation influenced their participation in the study. Quantitative data include responses to the question: “how much did the financial reward motivate you to…” “…join the study” (baseline) and “…come to clinic” (follow-up) on a Likert scale (1-10). IRB approval was obtained.

Results: To date, thirteen participants have been enrolled; one dropped out pre-intervention (n=12). Fifty percent (n=6) presented to the scheduled appointment, and 83.3% of them reported a higher financial-motivator score than at baseline (mean increase 4 points). The two participants who scored a 10 (“extremely motivating”) at baseline did not present to follow-up.

Discussion: Our initial study population, despite a global pandemic, demonstrates a high follow-up rate, and participants may not immediately recognize how motivating CM will be. This may be attributable to the enhanced linkage, which includes a small financial reward contingent on presentation. Follow-up CM has also been demonstrated in Hepatis C treatment (Norton et al. 2019).

Conclusion: Contingency management holds great potential for increasing treatment engagement in AUD, particularly during transitions from the hospital. This study demonstrates a significant increase in follow-up from pre-pandemic baseline (12%) to present (50%).



Koffarnus MN, Bickel WK, and Kablinger AS. 2018. “Remote Alcohol Monitoring to Facilitate Incentive‐Based Treatment for Alcohol Use Disorder: A Randomized Trial.” Alcoholism, Clinical and Experimental Research 42(12): 2423–31.

McDonell MG et al. 2017. “A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness.” The American Journal of Psychiatry 174(4): 370–77.

Norton BL et al. 2019. “Evaluation of Contingency Management as a Strategy to Improve HCV Linkage to Care and Treatment in Persons Attending Needle and Syringe Programs: A Pilot Study.” The International Journal on Drug Policy 69: 1–7.