Contingency Management (CM) is a behavioral intervention option for stimulant use that involves immediate, tangible rewards to individuals to reinforce positive self-identified behavior change. In 2023, in response to rising rates of stimulant overdose deaths, California became the first state in the U.S. to offer CM as a benefit through public insurance. Having already embraced CM over two decades prior through the Positive Reinforcement Opportunity Project (PROP)—originally designed for men who have sex with men to reduce sexually transmitted infections through reducing methamphetamine use—San Francisco was well positioned to expand this model, and over the last two years expanded CM to more than a dozen programs throughout the city benefitting diverse populations.

The San Francisco Department of Public Health (SFDPH) partnered with Facente Consulting to engage in focus groups and interviews with over 50 participants currently engaged in CM programs in San Francisco to assess impact and identify recommendations for programmatic expansion.