Real-World Implementation of Contingency Management and Benefits of a Controlled Environment "Head Start".

Objectives: To use quality improvement (QI) principles to implement contingency management (CM) in an outpatient clinic.

Methods: Prize-based CM was implemented for stimulant use disorder using standard protocols with QI processes used to improve efficiency and effectiveness.

Results: CM was successfully implemented in an outpatient addictions clinic using clinical funds. Participants who were discharged to the outpatient clinic from a controlled environment (such as hospital, withdrawal management, residential treatment program) had 8.3 (SD = 3.1) weeks of consecutive abstinence (CA) and 10.7 (SD = 1.0) weeks total abstinence.

Conclusions: Pragmatic clinical implementation of CM yielded results that are comparable to controlled trials in similar populations. QI processes identified that a controlled environment resulted in significant ongoing abstinence.CM was implemented in a small community clinic with no additional funding, and QI principles were used to improve efficiency and effectiveness. The initial implementation of 17 participants yielded a mean of 2.2 (SD = 3.2) weeks of CA. Recent discharge from a controlled environment resulted in 8.3 (3.1) weeks CA.