Contingency management treatment for substance abuse

We present the basics of contingency management treatment as it relates to substance abuse and drug addiction treatment here.

minute read

Everyone needs recognition for a job well done.

That’s just what contingency management (CM) does. Although critics claim that CM is an expensive way to bribe addicts for their sobriety, CM works. We review how and why here.

What is contingency management?

Contingency management is a treatment strategy used in inpatient and outpatient rehab settings where clinicians provide positive consequences to encourage positive behavior change and negative or punitive consequences for undesired behaviors. In other words, “good” behavior is rewarded (with transportation vouchers, prizes, gift certificates, and praise) while “bad” behavior is punished (probation officer reports, lost privileges, etc.).

For the most part, contingency management may sounds a lot like good parenting. And maybe drug addicts and alcoholics new to sobriety need both boundaries and rewards like kids learning the ropes. But contingency management is not for every rehab setting, or for every addict or alcoholic. So when and why does contingency management treatment for substance use work?

When does contingency management work?

Contingency management works when behaviors are monitored and consequences are reinforced immediately thereafter. Contingency management has exhibited positive clinical outcomes in inpatient and outpatient drug treatment programs that apply basic principles. Nancy M Petry, Ph.D. outlines these settings and situations in her recent book published by Routledge Press called Contingency Management for Substance Abuse Treatment. Her book is so thorough, in fact, that you can design your own contingency management program by following her suggestions. So how exactly does CM work?

CM can work in both residential and outpatient substance abuse treatment programs. CM is particularly useful in group therapy settings which meet once or several times per week. But in general, contingency management can work when clinicians follow three basic principles:

1. Frequently monitor the behavior that you are trying to change (via drug screens, taking attendance, or verifying work)

2. Provide tangible, immediate positive reinforcement each time that the behavior occurs (special privileges, money, methadone doses, vouchers, and prizes).

3. When the behavior does not occur, withhold the positive reinforcement.

But it must be understood that proper implementation of CM programs is important to its success. In particular, staff must monitor behaviors frequently and provide reinforcers consistently. In this way, CM interventions can effectively help:

  • reducing alcohol and drug use
  • retain alcoholics and addicts in treatment programs
  • improving medication compliance
  • promote participation in complementary programs (employment).

Why does contingency management work?

Contingency management works because we humans can be conditioned to learn new behaviors through repetition. Contingency management theory is based on the view that alcohol and drug use is a behavior that is influenced by neurological and environmental factors. The theory is that destructive substance use can be changed by offering consistent environmental consequences or alternatives that reinforce more positive, healthy behavior changes. In other words, using reinforcing or punishing consequences can alter the form and frequency of voluntary behavior. In psychology, this is known as operant conditioning.

Questions about contingency management

Do you have questions about implementing a CM program in your drug treatment facility? Or maybe you feel strongly about the use of contingency management for treating substance abuse. Either way please leave your your questions and comments below. We print and respond to all legitimate feedback.

Reference sources: Contingency Management for Substance Abuse Treatment: A guide to implementing this evidence-based practice, 2012 Nancy M. Petry
Contingency Management: Incentives for Sobriety
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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