Are Better Prizes Keeping Cocaine Addicts In Contingency Management Clean?
Contingency management is a form of behavioral psychotherapy known to help people recover from an addiction to the stimulant drug cocaine. This therapy uses vouchers or cash prizes to encourage recovering addicts to stay active in the treatment process and meet their program goals.
In a study published in June 2014 in the journal Drug and Alcohol Dependence, a team of researchers from Wayne State University investigated the question of whether the value of the reward offered during contingency management has an impact on the therapy’s chances of producing beneficial outcomes.
Cocaine Addiction Treatment
People addicted to cocaine have a chemical dependence stemming from the lasting changes that the drug makes inside their brains, as well as symptoms that indicate a loss of control over use of the drug and/or a clearly damaging pattern of behavior centered on drug use. When doctors treat certain forms of substance addiction, they can rely on medications proven to increase the odds that a client/patient will halt substance use and establish long-term abstinence.
However, although a number of medications show promise as potential treatments for cocaine addiction, doctors addressing this type of addiction do not currently have a reliable medication available for their use. This means that treatment programs for people addicted to the drug must use some form of counseling or psychotherapy to provide the needed assistance.
The form of psychotherapy most commonly employed for this purpose is behavioral therapy, a term that describes any therapeutic approach designed to modify and/or replace harmful behaviors that support continued involvement in substance use.
Contingency management (CM) is one of the most frequently used forms of behavioral therapy. One approach to the therapy, called voucher-based reinforcement, provides clients/patients with valuable vouchers as rewards for doing such things as producing drug-free urine tests, regularly attending treatment program activities and otherwise taking the steps required to establish drug abstinence and maintain that abstinence.
Within limits, people enrolled in voucher-based programs can choose how to redeem their vouchers.
Another approach to CM, called prize incentives contingency management, substitutes cash prizes for vouchers. When a client or patient participating in this type of contingency management reaches a program objective, he or she earns the chance to enter a drawing and win varying amounts of cash.
As a rule, the rewards in both types of contingency management go up when a program participant consistently meets his or her treatment goals.
Does The Value Of The CM Reward Matter To Addicts?
The Wayne University researchers assessed the impact of the value of the reward offered on the odds that a recovering cocaine addict will comply with his or her program objectives and avoid cocaine use.
During the study, 15 cocaine addicts participated in 10 sessions that required them to choose between drug use and taking the steps required to receive a financial reward for program compliance. During some of these sessions, the reward offered was $1; other sessions offered a reward of $3 for avoidance of cocaine use. In addition, during some of the sessions, the participants had a chance of winning $6, $12 or $24.
The conditions of the first two types of sessions mimicked the terms of voucher-based contingency management, while the conditions of the third type of session mimicked the terms of prize incentives CM. Prior to the main phase of the study, the researchers made sure that the enrolled participants still viewed cocaine use as an attractive and tempting option.
After completing their testing, the researchers concluded that, during the contingency management sessions that offered a fixed $3 reward for not using cocaine, the study participants were substantially more likely to avoid taking the drug than they were during the contingency management sessions that offered a $1 reward.
They also found that the same results held true when the study participants had to choose between using cocaine and taking a chance at winning $6, $12 or $24.
Are Both Alternative Addiction Treatment Programs Effective?
The results of the study generally confirmed the effectiveness of both voucher-based CM and prize incentives CM as methods for helping recovering cocaine addicts remain drug-abstinent.
The study’s authors also concluded that the chances that both of these approaches to contingency management will produce the desired benefits go up when the amount of the reward for avoiding drug use is relatively high.