The compatibility of employment-based contingency management and vocational services at the Department of Veterans Affairs.

The Department of Veterans Affairs (VA) provides vocational rehabilitation services for veterans with substance use disorders in programs such as Compensated Work Therapy (CWT). For some veterans, these services include regular monitoring and wages for work in prevocational settings. Independently of these services, the availability of a highly effective intervention for substance use disorders called contingency management (CM) has been rapidly increasing at the VA. CM involves the provision of material incentives such as prizes, vouchers, or money contingent upon verification of drug abstinence via toxicology screening. An employment-based version of CM has been demonstrated to be as effective as other forms of CM. Under this version of CM, access to paid employment or paid job training is the incentive. This employment-based CM could be used in conjunction with CWT or other vocational rehabilitation services used at the VA. The implementation of CM in such settings would increase access to CM for veterans and would be highly likely to improve substance use treatment outcomes among those receiving the service. This intervention might also improve key behavioral outcomes related to obtaining and maintaining competitive employment. VA officials in charge of employment-based treatment programs such as CWT should seriously consider integrating CM into their programs.