Contingency Management (CM) Therapy For Addiction
Medically reviewed byJohn Schaffer, LPCC
Contingency management therapy operates on an incentive-based system that helps encourage individuals to stay positive during recovery by offering rewards for completing activities or engaging in certain behaviors. This therapy model helps make addiction recovery a positive occurrence in an individual’s life.
The goal of contingency management (CM) therapy is to increase positive, healthy behaviors which promote abstinence and long-term recovery. Positive reinforcement and rewards-based incentives such as prize vouchers or cash prizes are used to encourage these behaviors. According to the National Institute on Drug Abuse (NIDA), CM effectively treats addiction to alcohol, marijuana, nicotine, opioids, and stimulants.
We all need encouragement and recognition throughout our lives. Feeling good and being appreciated can go a long way to increase an individual’s quality of life. For a person recovering from addiction, this support is priceless.
What Is Contingency Management?
How we learn and behave is largely shaped by the positive or negative consequences of our actions. This is the main component of operant conditioning, the behavioral learning theory behind contingency management. If certain behaviors are consistently reinforced or rewarded, there’s a higher chance they’ll be repeated in the future.
Inversely, if negative behaviors are not reinforced or if they’re punished, they should decrease over time. Many professionals agree that simply withholding the reward is often enough incentive or “punishment” to encourage participants to return to healthy behaviors.
Contingency management is supported by NIDA as an evidence-based behavioral therapy. It may be used within inpatient and outpatient settings. The recommended length for community-based programs is often three months. The National Institute of Justice asserts that intensive outpatient therapy may only last two to four weeks, whereas aftercare services may use CM upwards of a year or more.
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What Are The Goals Of Contingency Management?
The primary goal of contingency management is sobriety. A good treatment program should also stabilize the other areas of a person’s life which were damaged during addiction.
To create and maintain a fulfilling, drug-free life, CM:
- Decreases an individual’s alcohol and/or drug abuse until abstinence is reached
- Increases treatment retention rates
- Increases participation in treatment therapies and peer support groups
- Nurtures a person’s positive self-image and self-confidence
- Gives a person ownership over their recovery
- Encourages positive and self-directed goal setting
- Helps a person to take their medication correctly
Contingency management keeps participants engaged and focused on other critical recovery goals. Examples include becoming more involved in your children’s lives, finding and keeping a job, or addressing any medical and/or mental health care needs.
How Is Contingency Management Used Within Addiction?
While every program varies in its specific approach to CM, the overall emphasis is the same. As explained by NIDA, CM involves “giving patients tangible rewards to reinforce positive behaviors such as abstinence.” CM rewards the following behaviors:
- Drug-free urine tests
- Negative breath tests
- Participation in group counseling
- Taking medication as prescribed
- Other individualized goals within treatment
- Life goals (filling out a job application or keeping an important medical appointment)
If a person fails to reach these goals, they will not receive a reward and may face other consequences. Rewards may take the form of:
Voucher-Based Reinforcement (VBR)
This method is most typically based on urine screenings. Every time a person has a negative urine drug test, they receive a voucher. These vouchers are progressive, meaning they start small and become more significant over time. In these instances the “punishment” for a positive urine drug test would be that the individual has to return to the lowest valued voucher.
Addiction robs pleasure from a person’s life. These vouchers encourage people to develop healthy and sober ways to have fun and find fulfillment. To do this, as explained by NIDA, “the voucher has monetary value that can be exchanged for food items, movie passes, or other goods or services that are consistent with a drug-free lifestyle.” These rewards could include:
- Clothing and apparel
- Gift certificates
- Sporting goods
Other Types Of Reward
Some programs may give their clients a variety of prizes instead of vouchers. According to Psychiatric Times, some programs have rewarded homeless participants with housing or offered paid training to individuals enlisted within certain vocational programs. These incentives have a dual benefit as they encourage sobriety and the cultivation of important life skills.
In order for VBR to be effective, the vouchers or prizes must give a person the chance to obtain something they will actually use or value.
This is very similar to VBR, but instead of vouchers participants win cash prizes up to $100. Psychiatric Times reports that “typically, successful voucher programs have allowed for earnings exceeding $1,000 during a 12-week treatment period, and average earnings are about $600 per patient.”
In addition to negative urine tests, a person may also receive “draws” for a negative breath test or any of the factors we listed above. When a person achieves their goals they get to draw for a prize. The number of draws increases as positive behaviors climb. If a person fails a drug test or skips counseling they would start back over with only one draw.
What Types Of Addiction Can Contingency Management Treat?
The American Psychological Association writes that “CM treatments work across a broad array of substance use populations, including some of the most difficult to treat like pregnant women and those with serious mental illnesses.”
According to NIDA, contingency management can successfully treat:
Voucher-based reinforcement has been shown to be particularly helpful for those struggling with opioid or stimulant addiction. Further, heroin- and cocaine-addicted individuals are especially receptive to VBR. Psychiatric Times notes that CM improved treatment outcomes for benzodiazepine or polysubstance dependent individuals.
What Are The Benefits Of This Therapy?
Contingency management increases an individual’s chance of sobriety and program retention rates. It also increases a person’s:
- Positive goal-setting abilities
- Sense of self-worth
- Measure of self-care
- The general state of health and well being
Research suggests that CM works well with other treatment modalities. The Psychiatric Times article writes about a study on cocaine-dependent individuals in an outpatient setting. Seventy-five percent of those who received both vouchers and intensive behavioral therapy remained in treatment. This is compared to the 40 percent who remained after encountering only behavioral therapy.
While CM therapy could be more costly upfront, Psychiatric Times asserts that “CM interventions may ultimately save money through reduced hospitalizations, medical care, criminal justice system costs and public assistance payments and through increased productivity.”
Are There Any Negatives To Contingency Management?
After treatment, without the rewards, some individuals may become unmotivated and struggle to use the positive behaviors learned within CM. To address this, other behavioral therapies may be used to increase a person’s desire and motivation for change. Aftercare programs can help a person to remain focused on and committed to their recovery goals. Also, treatment costs for CM therapy may be more than other methods. This is because the prizes and incentives cost a fair amount of money. Even with these concerns, CM is still a very beneficial treatment modality.
Stay Motivated For A Drug-Free Life
Change can be difficult and it’s even harder on your own. If you or a loved one want to begin building a drug-free life, it’s important you take the right steps to get there. If you’d like to learn more about a drug rehab or aftercare program which uses contingency management therapy, look no further. RehabCenter.net can get you connected to the best treatment options for your needs. Contact us today.Article Sources
National Institute on Alcohol Abuse and Alcoholism - Contingency Management: Incentives for Sobriety
NIDA - Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine)
National Institute Of Justice - Program Profile: Prize-Based Incentive Contingency Management for Substance Abusers
American Psychological Association - Accentuate the Positive: Vouchers Help Drug Abusers Stay in Treatment