Posted by 
Contingency management is just one approach used in treatment and recovery from alcohol or other drug addictions. A quality treatment provider will employ a number of different evidence-based therapies, including Twelve Step Facilitation. According to a study published in the Journal of Dual Diagnosis, “dual diagnosis patients involved in contingency management-based care attended scheduled treatment sessions more than 50 percent more often than the patients not involved in contingency management-based care.” CM is an effective treatment for SUD because it’s based on behavioral therapy principles. In exchange for consistently responsible behavior, people get to draw for a chance to win cash prizes ranging from $1 to $100. However, the prize money resets to $1 if the person fails to meet a goal or pass a drug test.
Table of Contents
Efficacy of CM
A meta-analysis of controlled studies of psychosocial treatments for addiction (published in the American Journal of Psychiatry) observed that contingency management interventions demonstrate the largest reductions in drug use when compared with other treatment modalities. In a separate meta-analysis, contingency management treatment resulted in successful treatment episodes 61% of the time, while comparison treatments resulted in successful treatment episodes 39% of the time. Contingency management has demonstrated reductions in drug use that persist for 12–18 months after completion of the contingency management intervention in some randomized clinical trials. The long-term effects of contingency management on drug use have been found to be comparable with the long-term effects of cognitive behavioral therapies in the treatment of cocaine dependence.
Motivational incentives can also help participants build confidence over time, counteracting feelings of shame or low self-esteem. Ending treatment needs to be paired with relapse prevention strategies to reduce the risk of relapse. The value fun substance abuse group activities for adults of the vouchers starts low, increasing gradually with repeated good behavior.
- This study provided intensive behavioral therapy to another sample of cocaine-dependent outpatients, but one group received vouchers contingent upon drug abstinence while the other group did not.
- Any behavior changes made by patients that can improve their chances of successful recovery outcomes are not “artificial.” Even if individuals are showing up only for the chance to win, they are still choosing to be there.
- Such mechanisms include ways to identify and tap the beneficiaries of CM to contribute their share of the treatment costs, government subsidies, or some combination thereof.
How Does Contingency Management Differ from Other Therapy Approaches in Substance Abuse Treatment?
The premise behind CM is to utilize these and other reinforcement procedures systematically to modify behaviors of substance abusers in a positive and supportive manner (Petry, 2000). For example, in many CM treatments, patients leave urine specimens multiple times each week and receive explicit rewards for each specimen that tests negative for drugs. These rewards often consist of vouchers that have a monetary basis and can be exchanged for retail goods and services such as restaurant gift certificates, clothing, sports equipment, movie theater tickets and electronics. Contingency management is an efficacious intervention for substance use treatment and has been used successfully with sexual minority men who use methamphetamines in clinical trials and in community settings.
1 Background & clinical research
The incentive is compounded—they not only need to be on time to be entered into the next day’s drawing, but they also have to be on time the next day. Contingency management is primarily a process of systematically using positive reinforcement to promote clinically relevant behaviors that has demonstrated efficacy for improving abstinence in a diverse range of substance abuse treatment populations and settings (see Contingency Management). Briefly, contingency management is based on the behavioral principles of operant conditioning that predict that behaviors (e.g. smoking abstinence) that are reinforced or rewarded are more likely to recur. With this procedure, a target behavior is identified, like abstinence, and defined objectively (e.g. drug-negative urinalysis). It is monitored often to maximize chances for reinforcement and minimize failing to detect competing behaviors (e.g. drug use). When the target behavior occurs, tangible incentives or rewards (e.g. voucher) are provided, and incentives are not provided when the target behavior does not occur.
Relapse also occurs from this choice but can be reduced by presenting ‘free’ (i.e. unearned) rewards during the second phase (Bouton et al., 2017). Thus, this preclinical model may provide a useful behavioral assay to investigate contingency management treatment innovations to delay relapse, and enhance behavioral change, whilst also more accurately emulating clinical treatment settings. Contingency management is a type of behavioural therapy that has shown moderate success. Under this scheme addicts are rewarded for maintaining abstinence by, for example, receiving shopping vouchers in return for drug-free urine samples (Higgins et al., 1991). Contingency management has been demonstrated to reduce drug use for cocaine (Petry et al., 2004), heroin (Silverman et al., 1996) and marijuana (Budney et al., 2000), at least in the short-term.
Are there Certain Skills Required When Delivering this Approach?
However, for behaviors sun rock strain that rarely occur on their own or that are challenging in nature, external rewards may enhance engagement in them (Cameron, Banko, & Pierce 2001). Different associations may also relate to whether reinforcers are provided for attempting a task, finishing it, or reaching some threshold of performance (Cameron et al., 2001). Furthermore, most studies of the effects of external rewards were conducted in children or college students, not patients with serious physical or mental disorders. The manner in which external rewards impact internal motivations in patients receiving interventions that tangibly reward health behaviors remains unclear. The efficacy of contingency management has been demonstrated in community clinic settings in large randomized clinical trials.
It can include vouchers and access to specific privileges at the rehab (such as preferred times for appointments or parking spots). One well-known reinforcement intervention is known as the “fishbowl method.” This involves an intermittent reward schedule, where people who demonstrate the target behavior immediately draw a slip of paper and receive a prize from a selection kept at the rehab. Contingency management approaches employ a schedule of rewards to strengthen the practice of desired behaviors (e.g. abstinence, prosocial activities). These rewards may be small gifts, cash, or drinking when bored vouchers, which can be accumulated based on the duration of abstinence attained, as well as reversed upon a relapse. Although few studies have identified gender differences in response to contingency management, some interventions have been developed specifically for women.