Contingency Management in Substance Abuse Treatment

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From people in active recovery to advocates who have lost loved ones to the devastating disease of addiction, our community understands the struggle and provides guidance born of personal experience. Contingency management uses tangible rewards to encourage positive behaviors during addiction treatment, such as abstaining from drugs or alcohol. Through contingency management, also known as motivational incentives, individuals receive rewards for reaching substance abuse treatment milestones such as passing a drug test or attending counseling.

Rewards may include vouchers for retail goods or opportunities to win cash prizes. This type of therapy also involves withholding rewards from individuals who fail to adhere to their treatment plan.

Using Contingency Management for the Treatment of Substance Use Disorders in Real-World Settings

Clients who fail a drug or alcohol test, violate parole or fail to follow program rules could be punished for their actions. While some practitioners believe that certain aspects of contingency management can lead to gambling addiction, research has shown that the therapy is an effective approach for the treatment of a variety of drug problems. Before engaging in contingency management, clients often agree in writing to the parameters of the intervention.

This contract outlines the duration of intervention, frequency of drug testing and consequences of achieving or failing to meet desired behavioral changes. Both motivational incentives and motivational interviewing for substance abuse aim to help clients who have mixed feelings about sobriety succeed in recovery.

These treatment approaches differ, but research shows that using both during treatment can improve outcomes. Motivational interviewing strives to reduce uncertainties about discontinuing substance use or entering treatment. Through this technique, counselors lead conversations that encourage clients to change instead of teaching them how to change. Conversely, the contingency management approach provides incentives that promote abstinence. A study published in the Journal of Substance Abuse Treatment compared the substance use outcomes of adolescents receiving motivational interviewing interventions with the outcomes of teens receiving motivational incentives.

According to the results, teens who received motivational interviewing combined with contingency management showed a greater reduction in substance use at the conclusion of treatment than those who received motivational interviewing alone. Additionally, adolescents who received both interventions showed fewer negative consequences of marijuana use at the end of treatment, higher use of coping strategies and increased likelihood to attend additional treatment for drug use.

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  2. References.
  3. Contingency Management and Substance Use!

Contingency management can include voucher-based reinforcement or prize incentives. Both approaches aim to reward positive behavior, but they differ in the types of rewards given to individuals. Voucher-based reinforcement therapy rewards clients who pass a drug or alcohol test with vouchers or money-related incentives.

Vouchers can be exchanged for food items, movie passes or other goods or services consistent with an abstinent lifestyle. Vouchers increase in value as clients continue passing drug tests, but they reset in value upon a failed sample. According to the National Institute on Drug Abuse , this therapy approach can be combined with other treatments for adults who primarily abuse opioids, stimulants or both. For clients undergoing methadone detoxification, voucher-based reinforcement has shown effectiveness in promoting abstinence from cocaine and opioids.

Prize incentives contingency management allows clients to win cash prizes instead of vouchers for every drug-free urine sample or breath test provided. Participation in these programs generally lasts between two and four weeks during intensive outpatient therapy.

Individuals who draw low-valued chips may select from items such as snacks and fast-food gift certificates. But clients who draw chips higher in value could earn retail store gift certificates, CD players or televisions. In the s, research showed that contingency management can be used to alter behaviors in animals. In recent years, studies have demonstrated the effectiveness of this treatment approach in reducing alcohol- and drug-related behaviors in humans.

A study published in the Archives of General Psychiatry analyzed the effect contingency management interventions had on improving outcomes in cocaine or methamphetamine users beginning outpatient substance abuse treatment. Promotes active participation in other treatment-related goals, such as finding and keeping a job.

Find out more about other types of addiction therapies:. Zlomke L. Token Economies. The Behavior Analyst Today ; Lussier JP et al. A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction ; You are never too old to improve your health and quality of life!

Samantha Skelly. Celebrate Your Progress.

Lesley Wirth. Rules vs. The road to recovery can seem overwhelming. We are here to help. Am I Addicted? Take these quizzes to find out the depth of your addiction.

What Is Contingency Management Therapy?

In short, many people can benefit from contingency management. Contingency management therapy is often used to treat mental health conditions like depression, anxiety and eating disorders. Many therapists who work with children will also use and teach contingency management skills to parents. Children with conditions like attention-deficit hyperactivity disorder ADHD and oppositional defiant disorder tend to respond well to contingency management interventions, especially when parents reinforce desired behaviors at home.

In this way, children and parents both benefit from contingency management strategies. The children receive desirable rewards, and the parents receive the kind of behavior they want from their children. Recently, the use of contingency management in substance abuse treatment is on the rise.

Since substance abuse involves getting a rewarding feeling from negative behaviors, professionals use contingency management to reward positive behaviors. Motivational incentives in substance abuse treatment are recommended for numerous substance use disorders, including those involving:.

Although all contingency management plans involve the parent or therapist providing a reward to the client when they complete a wanted action, not all contingency management programs are identical. There are two main types of contingency management programs: voucher-based reinforcement and prize incentive programs.


Voucher-based reinforcement VBT is mostly used with adults who abuse opioids, stimulants or both. In VBT, the person receives a voucher each time they submit a clean urine sample. Patients can exchange these vouchers for goods and services like food, movie passes and music. At the beginning of VBT, the vouchers earned have little value, but as the period of abstinence increases, the vouchers grow in value. This way, the reinforcement gained from continued sobriety offsets any perceived benefit seen in relapse.

Prize incentives use a similar structure as VBT, with participants earning chances to receive prizes for each recovery-focused behavior they complete. Rewarded recovery-focused behaviors typically include:. For every successful activity, the person receives one chance to reach into a bowl and pull out a prize written on a piece of paper.

The variability of prize incentives adds an element of excitement and uncertainty, as the person has no idea what their reward will be. The benefits of contingency management in addiction treatment are numerous. Anyone looking for professional intervention should consider contingency management in substance abuse treatment. To begin, contingency management treatment is readily available. Since many therapists receive training and supervision in contingency management, it should not be challenging to find a professional willing to provide these services.

Contingency management is available in schools and the community as well. The effectiveness of motivational incentives in substance abuse treatment is backed by decades of research. A person beginning the service can feel reasonably comfortable in knowing their symptoms will improve with the approach. Because contingency management is a widely-regarded as a beneficial treatment, insurance companies are happy to cover the services. Perhaps the greatest asset of contingency management is the low risk.

As long as the treatment provider does well to assess the situation appropriately and follows the principles of contingency management, the client is not in danger of any hazard or harm. Despite all of the benefits, there are still some barriers to effective contingency management treatment. Being aware of these can help the client, their family and the treatment provider overcome issues to increase the possibility for desirable outcomes.

As mentioned, contingency management rewards tend to start small and grow in value as time goes on. This increase in reinforcement means that successful clients will be more expensive to treat as time goes on.