Addiction specialists' perspectives on digital contingency management and its role within UK drug and alcohol services: A qualitative exploration.

Introduction: Contingency management (CM), based on the principles of operant conditioning, uses positive reinforcement to promote behaviour change in individuals with substance use disorder. Research on CM has grown exponentially, with technology being used to expand the reach and scope of these interventions. The views of policy professionals and treatment providers on the remote delivery of CM are likely to play an important role in the development and application of these interventions.

Methods: Semi-structured qualitative interviews, analysed using framework analysis, were conducted with 22 UK-based addiction specialists to explore their views on digital CM, including its place within UK drug and alcohol services and future developments. Participants included commissioners, policy professionals and clinicians.

Results: CM was widely acknowledged as an effective, scientifically grounded and appropriate treatment approach for drug treatment and recovery. While addiction specialists see CM as a powerful tool in a comprehensive addiction treatment toolkit, they identify the barriers impeding its implementation, including a lack of awareness among treatment providers, commissioning challenges, resource constraints and ethical concerns. Remote delivery of CM was considered a promising approach for overcoming some of these barriers and enhancing CM delivery and engagement.

Discussion and conclusions: Technology needs to be integrated into clinical practice to expand the reach of treatment. While current evidence supports digital CM, concerns about digital literacy, technological barriers, resource constraints, public acceptability and political hesitancy highlight the need for further research to validate its feasibility and to explore the extent to which it should complement, rather than replace, in-person treatment options.