Table 4 Contingency management beliefs questionnaire responses (n = 123)

I think the research evidence about CM’s effectiveness does not apply to our everyday clients.

23 (18.7%)

15 (12.2%)

50 (40.7%)

22 (17.9%)

13 (10.6%)

2.9 (1.2)

I am worried about what happens once the contingencies are withdrawn.

25 (20.3%)

17 (13.8%)

51 (41.5%)

19 (15.5%)

11 (8.9%)

2.8 (1.2)

I am concerned clients might sell/trade earned items for drugs.

31 (25.2%)

26 (21.1%)

38 (30.9%)

20 (16.3%)

8 (6.5%)

2.6 (1.2)

CM doesn’t address the underlying cause of the clients’ health needs.

31 (25.2%)

28 (22.8%)

40 (32.5%)

15 (12.2%)

9 (7.3%)

2.5 (1.2)

CM might cause arguments among clients (e.g., when some get prizes and other do not).

39 (31.7%)

29 (23.6%)

36 (29.3%)

11 (8.9%)

8 (6.5%)

2.3 (1.2)

I think that providing prizes undermines the clients’ internal motivation to reduce opioid use.

45 (36.6%)

28 (22.8%)

36 (29.3%)

5 (4.1%)

9 (7.3%)

2.2 (1.2)

I do not have time to administer prizes in my routine sessions.

56 (45.5%)

25 (20.3%)

29 (23.6%)

4 (3.3%)

9 (7.3%)

2.1 (1.2)

My clinical experience with individuals with substance use is more important than any research evidence.

52 (42.3%)

25 (20.3%)

34 (27.6%)

5 (4.1%)

7 (5.7%)

2.1 (1.2)

The community wouldn’t understand (i.e., clinic will look bad for giving rewards to individuals who use opioids).

49 (39.8%)

34 (27.6%)

28 (22.8%)

8 (6.5%)

4 (3.3%)

2.1 (1.1)

CM is expensive (e.g., cost of prizes).

53 (43.1%)

28 (22.8%)

34 (27.6%)

3 (2.4%)

5 (4.1%)

2.0 (1.1)

It seems like CM interventions create extra work for me.

55 (44.7%)

29 (23.6%)

30 (24.4%)

5 (4.1%)

4 (3.3%)

2.0 (1.1)

A lot of my clients are already abstinent from opioids at intake, so they don’t need CM.

52 (42.3%)

35 (28.5%)

28 (22.8%)

5 (4.1%)

3 (2.4%)

2.0 (1.0)

I think clients will view CM as patronizing.

52 (42.3%)

35 (28.5%)

27 (22.0%)

6 (4.9%)

3 (2.4%)

2.0 (1.0)

I am not convinced by the research about CM’s effectiveness.

65 (52.9%)

19 (15.5%)

29 (23.6%)

7 (5.7%)

3 (2.4%)

1.9 (1.1)

I believe it is not right to give rewards for abstinence from opioids if clients are not meeting other treatment goals (e.g., PrEP adherence).

64 (52.0%)

25 (20.3%)

26 (21.1%)

1 (0.8%)

7 (5.7%)

1.9 (1.1)

Our clinic rules prevent urine screening for opioid use.

82 (66.7%)

11 (8.9%)

17 (13.8%)

2 (2.4%)

10 (8.1%)

1.8 (1.3)

I find CM distasteful because it is basically paying someone to do what they should do already.

74 (60.2%)

22 (17.8%)

19 (15.5%)

5 (4.1%)

3 (2.4%)

1.7 (1.0)

I want more training before implementing CM.

20 (16.3%)

14 (11.4%)

44 (35.8%)

22 (17.9%)

23 (18.7%)

3.1 (1.3)

I don’t feel qualified or properly trained to administer CM interventions.

40 (32.5%)

17 (13.8%)

42 (34.2%)

12 (9.8%)

12 (9.8%)

2.5 (1.3)

Currently, no one in my facility has the experience to supervise CM.

53 (43.1%)

18 (14.6%)

36 (29.3%)

7 (5.7%)

9 (7.3%)

2.2 (1.3)

My agency / supervisors / administrators do not support CM (e.g., do not provide training, resources).

60 (48.8%)

17 (13.8%)

34 (27.5%)

6 (4.9%)

6 (4.9%)

2.0 (1.2)

Any source of motivation, including extrinsic motivation, is good if it helps get clients involved and responding to treatment.

5 (4.1%)

6 (4.9%)

32 (26.0%)

37 (30.1%)

43 (35.0%)

3.9 (1.1)

I think that CM is worth the time and effort if it works.

6 (4.9%)

7 (5.7%)

31 (25.2%)

39 (31.7%)

40 (32.5%)

3.8 (1.1)

I am in favor of adding CM interventions to our existing services.

5 (4.1%)

10 (8.1%)

33 (26.8%)

35 (28.5%)

40 (32.5%)

3.8 (1.1)

CM is useful when targeting treatment goals for opioid use disorder other than abstinence from opioids (attendance, activities).

2 (1.6%)

7 (5.7%)

48 (39.0%)

40 (32.5%)

26 (21.1%)

3.7 (0.9)

CM is helpful because it helps keep clients engaged in treatment long enough for them to really learn valuable skills.

6 (4.9%)

5 (4.1%)

47 (38.2%)

35 (28.5%)

30 (24.4%)

3.6 (1.1)

It seems to me that CM is good for clients because they get excited about their treatment and progress.

6 (4.9%)

4 (3.3%)

46 (37.4%)

43 (35.0%)

24 (19.5%)

3.6 (1.0)

I think CM focuses on the good in clients’ behavior, and not just what went wrong.

10 (8.1%)

7 (5.7%)

44 (35.8%)

31 (25.2%)

31 (25.2%)

3.5 (1.2)

I think CM will help get clients in the door (e.g., motivate them to come to treatment).

6 (4.9%)

10 (8.1%)

47 (38.2%)

33 (26.8%)

27 (22.0%)

3.5 (1.1)

CM is useful when targeting opioid abstinence.

5 (4.1%)

10 (8.1%)

47 (38.2%)

35 (28.5%)

26 (21.1%)

3.5 (1.0)

CM helps clients reduce their opioid use so that they can work on other aspects of treatment.

8 (6.5%)

10 (8.1%)

52 (42.5%)

29 (23.6%)

24 (19.5%)

3.4 (1.1)

CM is good for the client-counselor relationship.

10 (8.1%)

13 (10.6%)

52 (42.3%)

30 (24.4%)

18 (14.6%)

3.3 (1.1)

It is preferable to give clients prizes in choice of goods/supplies/gift cards (rather than cash) for reaching treatment goals.

9 (7.3%)

8 (6.5%)

32 (26.0%)

43 (27.6%)

40 (32.5%)

3.7 (1.2)

CM is useful for targeting HIV prevention with PrEP.

3 (2.4%)

5 (4.1%)

50 (40.7%)

38 (30.9%)

27 (22.0%)

3.7 (0.9)

It is okay for a client to have the opportunity to earn prizes worth as much as $100 for reaching treatment goals.

12 (9.8%)

11 (8.9%)

33 (26.8%)

34 (27.6%)

33 (26.8%)

3.5 (1.3)

The activity contracting in CM allows us to individualize goals to a specific client’s needs.

15 (12.2%)

14 (11.4%)

42 (34.2%)

37 (30.1%)

15 (12.2%)

3.2 (1.2)

Urine testing is easy to fit into my workflow.

23 (18.7%)

16 (13.0%)

40 (32.5%)

21 (17.1%)

23 (18.7%)

3.0 (1.3)

Reinforcing PrEP adherence via urine testing will help motivate clients to be consistent with their medication.

14 (11.4%)

22 (17.9%)

52 (42.9%)

21 (17.1%)

14 (11.4%)

3.0 (1.1)

Because many of our clients are difficult to contact regularly, CM is not feasible.

32 (26.0%)

26 (21.1%)

52 (42.3%)

8 (6.5%)

5 (4.1%)

2.4 (1.1)

It is preferable to give clients prizes in cash for reaching treatment goals.

48 (39.0%)

21 (17.1%)

31 (25.2%)

12 (9.8%)

11 (8.9%)

2.3 (1.3)

CM is not flexible enough for our clients who may not be ready to make changes.

44 (35.8%)

25 (20.3%)

40 (32.5%)

9 (7.3%)

5 (4.1%)

2.2 (1.1)

I feel like CM targeting opioid abstinence is not compatible with a harm reduction approach.

53 (43.1%)

25 (20.3%)

32 (26.0%)

8 (6.5%)

5 (4.1%)

2.1 (1.1)

It seems like activity contracting takes too much time.

45 (36.6%)

32 (26.0%)

35 (28.5%)

7 (5.7%)

4 (3.3%)

2.1 (1.1)

Finding verifiable activities for CM is too difficult and time-consuming.

47 (38.2%)

26 (21.1%)

39 (31.7%)

7 (5.7%)

4 (3.3%)

2.1 (1.1)

Our clients will not be interested in prizes for opioid abstinence.

60 (48.8%)

27 (22.0%)

22 (17.9%)

7 (5.7%)

7 (5.7%)

2.0 (1.2)

Our clients will not be interested in prizes for PrEP adherence.

63 (51.2%)

22 (17.9%)

23 (18.7%)

8 (6.5%)

7 (5.7%)

2.0 (1.2)

I believe it is not right to give rewards for PrEP if clients are not meeting other treatment goals (e.g., MOUD engagement).**

60 (49.2%)

29 (23.8%)

25 (20.5%)

3 (2.5%)

5 (4.1%)

1.9 (1.1)