Contingency Management Keep Addicts In Treatment Longer

People addicted to opioid narcotics (and other drugs of abuse) often have additional mental health issues that significantly complicate their recovery during addiction treatment. In many cases, the situation is worsened by recovering addicts’ relatively infrequent use of available psychiatric services. In a study published in November 2013 in the journal Drug and Alcohol Dependence, researchers from Johns Hopkins University assessed the usefulness of an approach called contingency management (CM) in increasing recovering  opioid addicts’ willingness to participate in psychiatric treatment. The researchers found that appropriate use of contingency management can significantly boost program participants’ attendance for psychiatric services.

Opioid Addiction And Mental Illness

Like other forms of drug and alcohol addiction, opioid addiction is officially classified as a form of mental illness by the American Psychiatric Association. This is true because continued, excessive use of addictive substances literally alters the function of the human brain, and thereby fosters a range of serious, dysfunctional changes in everyday behavior. In addition, opioid addictions (and other substance addictions) often appear at the same time as other forms of diagnosable mental illness such as depression, schizophrenia or anxiety disorders.

Numerous factors help explain the overlap between addiction and these mental illnesses, including the ability of substance abuse/addiction to trigger the onset of additional illness and the ability of non-substance-based mental illnesses to increase the risks for involvement in substance use. Research also indicates that substance addiction and other forms of mental illness share several important common risk factors that increase their likelihood of appearing together.

Contingency Management Basics

Contingency management is a behavior modification technique that uses rewards (and, in some cases, punishments) to bring about desired results in a drug treatment program or other therapeutic setting. One common form of this approach, called voucher-based reinforcement or VBR, uses the distribution of vouchers for services or material goods to encourage treatment compliance.

Another form of CM, called prize incentives contingency management, motivates compliance by giving patients a chance to win cash with every significant step toward active treatment participation. Contingency management is used in programs that treat addiction to substances such as opioid narcotics, marijuana, amphetamine, methamphetamine, alcohol and nicotine. Some programs use the technique to encourage abstinence during the course of recovery. Others use it to encourage participation in the psychiatric programs that address other forms of mental illness in people involved in substance addiction treatment.

Addicts Willing To Remain In Drug Rehab With Contingency Management

In the study published in Drug and Alcohol Dependence, the Johns Hopkins University researchers used an assessment of 125 adults going through outpatient treatment for opioid dependence to gauge the effectiveness of contingency management in improving the willingness to receive psychiatric services during participation in an addiction recovery program. Half of these individuals received $25 vouchers for each week of full participation in a 12-week course of psychiatric treatment. The remaining adults had access to the same psychiatric treatment, but did not receive vouchers or any other form of reward for treatment attendance. The researchers measured each group’s level of attendance after each month of the program.

After reviewing their findings, the researchers concluded that, compared to an approach that doesn’t employ contingency management, use of voucher-based CM nearly doubles the level of psychiatric treatment attendance after one month of treatment. In addition, use of vouchers more than doubles the level of attendance after two months of treatment and after three months of treatment. People who receive vouchers for psychiatric services remain in opioid addiction treatment just as often as people who don’t receive vouchers. They also successfully avoid using opioid drugs with equal frequency.

Contingency Management’s Clear Benefits In Addiction Programs

The authors of the study published in Drug and Alcohol Dependence believe that the use of contingency management techniques provides clear benefits for encouraging the use of psychiatric services in opioid addiction programs. However, they note that their research only looked at psychiatric services delivered to patients in a purposeful, coordinated manner during the course of addiction treatment.

Services delivered in other ways may or may not receive the same attendance boost from the contingency management approach. The authors also note that the specific type of psychiatric treatment offered in any given program may have a considerable impact on the usefulness of CM. In addition, program managers may need to alter or modify their use of CM in order to meet the specific challenges faced by their patient clientele.

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