Contingency management uses tangible rewards to encourage positive behaviors during addiction treatment, such as abstaining from drugs or alcohol. The conceptual framework is modeled after operant conditioning, a learning process through which rewards are used to modify a person’s behaviors.
Through contingency management, also known as motivational incentives, individuals receive rewards for reaching 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. 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, including those related to:
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 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 2015 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.
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.
Participants who pass their drug test, attend counseling or achieve other treatment goals draw from a bowl containing chips that range in value from $1 to $100. 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.
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In the 1980s, 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 2005 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.
According to the results, contingency management interventions helped participants:
A 2006 study published in the journal Addiction examined the effectiveness of contingency management in treating addictions to illicit drugs such as cocaine, alcohol and tobacco. The results suggested that contingency management was one of the more effective therapy approaches for promoting abstinence during addiction treatment.
Not everyone supports the use of contingency management. In fact, some practitioners have expressed concern that this therapy approach could lead to a gambling addiction.
For example, practitioners have said that prize incentives contingency management promotes gambling because the intervention incorporates the element of chance. But the National Institute of Justice rated this version of contingency management as effective in treating substance abuse problems, and other studies have contradicted claims that the therapy results in gambling addiction.
A 2010 study published in the Journal of Substance Abuse Treatment examined research findings on motivational incentives in the National Drug Abuse Treatment Clinical Trials Network. In the report, researchers found no differences in gambling behaviors between clients who received incentives and individuals receiving other treatments.
The effectiveness of contingency management interventions in reducing substance use, increasing retention rates and promoting healthy behaviors has made the approach a promising component in treating drug and alcohol abuse.