Recovery Incentives Program: California’s Contingency Management Benefit

Adults who (1) are enrolled in Medicaid and meet access criteria for a comprehensive, individualized course of Stimulant Use Disorder (SUD) treatment; (2) reside in a county that elects to and is approved by the state to participate in the state’s Drug Medicaid Organized Delivery System; and (3) receives services in nonresidential level of care operated by a drug Medicaid organized delivery system provider participating in the Program and offering contingency management (CM) in accordance with state policies and procedures

The Recovery Incentives Program: California’s Contingency Management Benefit is a structured 24-week outpatient contingency management (CM) program, followed by six or more months of additional recovery support services. CM is a behavioral intervention that recognizes and reinforces individual positive behavior change consistent with meeting treatment goals, including medication adherence, as well as substance and stimulant nonuse. Through the Recovery Incentives Program, noncash incentives are rewarded for nonuse of stimulants (e.g., amphetamines, cocaine, and methamphetamine) as evidenced by negative point-of-care urine drug tests. Motivational incentives are an inherent and central element of CM treatment. The immediate delivery of the incentive is designed to help tip decision-making toward avoiding stimulant use to manage difficult periods.

The Recovery Incentives Program: California’s Contingency Management Benefit is available for individuals under the age of 18 as well; however, the CEBC has only reviewed this program in the Substance Abuse Treatment (Adult) topic area so the entry only mentions adults.

Beth A. Rutkowski, MPH

• Title: Co-Principal Investigator/Co-Lead for Training and Implementation Support
• Agency/Affiliation: UCLA Integrated Substance Use and Addiction Programs
• Website: https://uclaisap.org/recoveryincentives/; https://www.dhcs.ca.gov/Pages/DMC-ODS-Contingency-Management.aspx
• Email: brutkowski@mednet.ucla.edu
• Phone: (310) 267-5397

The goals of the Recovery Incentives Program: California’s Contingency Management Benefit are:

• Increase ability to reduce or stop stimulant use
• Strengthen motivation to engage in treatment and recovery activities
• Improve consistency in attending outpatient treatment sessions
• Support ability to maintain consecutive stimulant‑negative drug tests
• Enhance overall physical and behavioral health
• Improve daily functioning, stability, and ability to meet personal responsibilities
• Increase confidence in maintaining long‑term recovery from stimulant use disorder
• Strengthen connection to ongoing treatment, recovery supports, and community resources
• Reduce risk of stimulant‑related overdose or other serious health harms
• Improve overall quality of life and sense of well‑being

The essential components of Recovery Incentives Program: California’s Contingency Management Benefit include:

• The overarching goals:
  • Expand access to a behavioral treatment for stimulant use disorder designed to reduce stimulant overdose deaths associated with the use of stimulants
  • Increase retention in outpatient treatment settings
• Behavior for Reinforcement:
  • Stimulant abstinence as measured by point-of-care urine drug tests (UDTs) for amphetamine, methamphetamine, and cocaine. This behavior is objective, observable, and easily measurable
  • Clear and unambiguous for the member and CM team member, and achievable for the member
• Frequency of Monitoring and Reinforcement:
  • Monitoring is frequent and feasible, involving twice-weekly on nonconsecutive days, such as Mon/Thurs or Tues/Fri for the first 12 weeks and once weekly in weeks 13-24
• CM Intervention:
  • 12-weeks of CM starting at $10 for each stimulant-abstinent sample, escalating by $1.50 for each week of consecutive abstinence (assessed twice-weekly
  • Followed by a 12-week stabilizing period in which UDTs are collected once per week and stimulant-free samples are rewarded with either a $10 or $15 gift card, with a final possible gift card worth $21 in week 24.
• The CM rewards (reinforcers):
  • Contingent (only provided when the focused behavior occurs)
  • Tangible (restricted gift cards are delivered in the form of an e-mail, text link, or printed voucher)
  • Desirable (members can choose from over 30 vendors)
  • Immediate (delivered as soon as the behavior is achieved and verified)
  • Escalating (see below)
  • Closely tracked (through the web-based Incentive Manager (IM) Portal)
• Reinforcement Amount, Escalation, Reset, and Recovery –
  • Core Sessions:
    • Gift card values for each qualifying urine sample are at least $10.
    • For each week the member achieves/maintains abstinence (i.e., two consecutive stimulant-abstinent UDTs), the gift card value increases by $1.50.
    • Maximum a member earns if they attend every CM visit and maintain abstinent for the entire 12 weeks is $438.
  • Recovery Sessions:
    • During weeks 13-18, members test once per week and earn $15 for each negative test.
    • Weekly testing continues in weeks 19-23 with each negative test earning $10.
    • In week 24, a negative test earns the member $21.
    • Thus, a member can earn a maximum of $161 for weeks 12-24, for a total of $599 across the entire 24-week period if they attend every visit and submit a stimulant-negative UDT every visit.
  • Although the total reward per member may be as high as $599, it is unlikely that everyone will achieve this level of success in CM. Due to missed appointments and periodic stimulant use, the average cost of incentives in your implementation of the Recovery Incentives Program will be approximately half of the maximum amount possible ($599), or approximately $300 per member.
  • A reset occurs when a member submits a stimulant-positive UDT or has an unexcused absence. The next time they submit a stimulant-negative UDT, their reward level “resets” to the initial incentive value (e.g., $10).
  • A recovery occurs after two consecutive stimulant-negative urine tests. At that time, the member “recovers” their previously earned incentive level plus the next escalation of $1.50.
• Gift Cards –The Incentive Manager (IM) Portal manages incentives and dispenses gift cards, because they are both desirable and feasible.

Adult Services

Recovery Incentives Program: California’s Contingency Management Benefit directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

• Enrolled in their state Medicaid program with moderate or severe cocaine or stimulant use disorder diagnoses, including diagnoses in remission and a determination of medical necessity (which includes establishment of impairment and a covered diagnosis); the stimulant is often taken in larger amounts or over a longer period than was intended plus the following: a persistent desire or unsuccessful efforts to cut down or control stimulant use; a great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects; craving, or a strong desire or urge to use the stimulant; recurrent stimulant use resulting in a failure to fulfil major role obligations at work, school, or home; continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant; important social, occupational, or recreational activities are given up or reduced because of stimulant use; recurrent stimulant use in situations in which it is physically hazardous; stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant; tolerance, as defined by either of the following – A need for markedly increased amounts of the stimulant to achieve intoxication or desired effect or a markedly diminished effect with continued use of the same amount of the stimulant; withdrawal, as manifested by either of the following – The characteristic withdrawal syndrome for the stimulant or the stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms

Recommended Intensity

Members participate in twice weekly visits in Weeks 1-12 and once weekly visits in Weeks 13-24; the CM service is billed in 15-minute increments. The duration for CM visits averages 15-30 minutes.

Recommended Duration

24 weeks/6 months

Delivery Settings

This program is typically conducted in a(n):

• Community-based Agency / Organization / Provider
• Outpatient Clinic

Homework

This program does not include a homework component.

Languages

Recovery Incentives Program: California’s Contingency Management Benefit has materials available in the following languages other than English:

• Braille
• Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed in this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

A bathroom, office space, Wi-Fi/Internet access, computer, and printer.

Prerequisite/Minimum Provider Qualifications

At least one CM coordinator shall administer CM services at each participating DMC-ODS provider site. Practitioners eligible to deliver the CM benefit include: Licensed Professionals of the Healing Arts, substance use disorder counselors who are either certified or registered by an organization that is recognized by the California Department of Health Care Services and accredited with the National Commission for Certifying Agencies, certified peer support specialists, and other trained staff under the supervision of an LPHA (the designation “Other trained staff under supervision of an LPHA” is specific to CM and does not change existing requirements for providers of other DMC-ODS services).

There are no stated minimum education requirements aside from those needed to become the professions listed above.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

• Peck, J. A, Freese, T. E, Rutkowski, B. A., McDonell, M., Parent, S., & Hirchak, K. (2023). Recovery Incentives Program: California’s Contingency Management Benefit Program manual. UCLA Integrated Substance Use and Addiction Programs. https://uclaisap.org/recoveryincentives/docs/training/Program-Manual-with-Appendices-2025-08-26.pdf

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Individuals from other states who wish to discuss implementing a similar program may reach out to the training contact above.

Number of days/hours:

The consultation hours may vary but the online trainings would be part of it:

CM Overview Training = 2 hours
https://uclaisap.inreachce.com/details/Information/58dc4a47-81e8-4846-84bc-e428001ba5fc

2-Part Implementation Training = 6 hours (two 3-hour sessions)
https://uclaisap.org/recoveryincentives/trainings.html

For questions on these online trainings, please reach out to Caitlin Thompson, MPP, MPH at CAThompston@mednet.ucla.edu

• There are currently no published, peer-reviewed research studies on outcomes with the appropriate target population for the topic area(s) in which Recovery Incentives Program: California’s Contingency Management Benefit has been reviewed.

• Urada, D., Padwa, H., Antonini, V. Tsoi, C., Gregorio, L., Freese, T., Rutkowski, B., Rawson, R., Lee, A. N., Bass, B., Khurana, D., Loya, C., Cooper, M., Gilbert, M., & Zakher, E. (2025). Evaluation of the Recovery Incentives Program: California’s contingency management benefit. Drug and Alcohol Dependence, 267(S). https://doi.org/j.drugalcdep.2024.112298 

• Rawson, R. (2025). Escalating stimulant involvement in overdose deaths makes effective treatment for cocaine and methamphetamine addiction and urgent priority. ATTC Network Coordinating Office. https://attcnetwork.org/addiction-messenger-feature-article-july-2025/. 

• Show the Good. (2025). Recovery Incentives Program: California’s Contingency Management Benefit brief video. https://vimeo.com/1092526189?share=copy#t=0.