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Does Contingency Management In Substance Abuse Treatment Work?

Addiction Treatments
Does Contingency Management In Substance Abuse Treatment Work?

Does Contingency Management In Substance Abuse Treatment Work?

Choosing the right alcohol or drug rehab treatment strategy can be a challenge for someone still struggling with addiction. One of the most confusing aspects for many is simply figuring out which therapy does what. It’s critical information because it will guide you toward making the best decisions regarding treatment. This article will help you understand the treatment approach known as contingency management (CM) and how it helps addicts during recovery.

Contingency Management Basics

Contingency Management In Drug Rehab Treatment | CM Treatment TherapyContingency management is based on a simple principle: behavior that is rewarded is behavior more likely to be repeated in the future. It’s a principle we see all the time in everyday life. For example, a teen may earn an allowance for taking on extra chores, or a boss may award her employees with bonuses for excellent performance.

Although it can be used to treat alcohol abuse, CM is most commonly employed as to treat drug abuse and addiction. The therapy is also used by health professionals to help people overcome a range of challenges, including weight loss, exercise motivation, and cigarette smoking. Additionally, contingency management is sometimes utilized to increase the likelihood a patient will take medication as directed.

How Exactly Is CM Used In Substance Abuse Treatment?

During substance abuse treatment, CM reinforces positive, drug-free behavior with explicit, tangible rewards. One of the most common ways to use this reinforcement is to allow addicts to earn vouchers for goods and services, like movie tickets, retail goods, sports equipment, or electronics, after they’ve submitted a specified number of drug-free urine samples. In some programs, the reward has a fixed dollar amount, such as $25. Other treatment plan rewards may increase in value the longer the drug abuser stays clean.  For example, a voucher may hold a starting value of $10 and increase by $2 for each negative sample the addict provides. The goal is to encourage substance abusers to remain abstinent during outpatient treatment.

Why CM Promotes Healthy Behaviors In Addicts

In addition to promoting abstinence, CM can be used to promote other healthy behaviors in addicts. Addiction therapists may reward patients for attending a certain number of 12-step meetings or showing positive behaviors during drug rehab treatment. One program offered housing and behavioral treatment to homeless cocaine addicts in exchange for staying drug-free [1].

Another form of contingency management involves medication for methadone patients. Recovering addicts may be permitted to take methadone doses home if they increase positive behaviors or cease negative ones. A patient, for instance, could earn the right to take home one dose a week after submitting a specific number of drug-negative urine tests.

Contingency management can be an appropriate treatment for many addicts, however, it’s considered especially helpful for those in high-risk groups. For example, this drug rehab treatment has been used to reduce dangerous injection-related behaviors, which increase the risk of acquiring HIV and other bloodborne diseases [2]. CM has also been used successfully to treat pregnant women with addiction. One review of numerous studies concluded that contingency management was more effective at keeping pregnant women in drug treatment than motivational interviewing, another addiction therapy [3].

Effectiveness Of Contingency Management For Drug Abuse

Contingency management has proved to be an effective treatment for substance abuse disorders. One review of 47 studies found that incorporating it into treatment improved drug abstinence rates during recovery. However, it also suggested that contingency management may be more effective for those with opiate or cocaine addiction than for those with multiple drug addictions [4].

Research also suggests CM is useful for keeping addicts in outpatient therapy. Typically, many substance abuse patients miss scheduled appointments; one estimate puts the number as high as 60%. However, in one study, researchers gave addicts who attended scheduled group therapy the chance to draw from a prize bowl, which contained vouchers for prizes ranging from $1 to DVD players.  Recovering addicts were more likely to attend weekly sessions when reinforced with contingency management than when they were not [5]. Another study discovered that 84% of outpatient substance abusers receiving vouchers stayed in treatment over 8 weeks, while only 22% of non-voucher patients did so [6].

Contingency Management Drug Addiction Treatment Plan

Like many drug rehab treatment options, CM is not intended to be used as a sole therapy. It’s often used in conjunction with other addiction treatments. For example, cognitive-behavioral therapy (CBT) is one approach a therapist could pair with contingency management. During CBT, the alcoholic or drug addict will identify the negative behaviors and emotions that contribute to addiction.

The cost of contingency management can prevent some substance abuse clinics from using this therapy. Some evidence suggests that CM is not as effective when the value of the vouchers is too low [7]. The cost of vouchers attractive enough to change addiction behavior can quickly add up. In one study, addicts received vouchers worth more than $1,000 over the course of treatment [8].

Some experts have raised concerns that incentives, such as those that allow substance abusers the opportunity to draw a random prize from a bowl, increase the risk for pathological gambling. However, prize drawings in CM have not been shown to promote excessive gambling, according to the National Institute on Drug Abuse [9].

Critics Of Contingency Management For Drug Rehab Treatment

Contingency management is not without critics. Some opponents of this approach assert that contingency management amounts to bribing drug users to stay clean. Another concern of critics is that some addicts will deceive treatment professionals by providing clean urine samples that do not belong to them, thus collecting the incentive without meeting their own obligation to stay abstinent. Additionally, those against this approach argue that CM does not directly address underlying issues that contribute to substance abuse. However, it’s important to note that contingency management is often paired with other treatments developed to produce long-term behavioral changes.

Drug rehab treatment may be one of the most important decisions you’ll ever make. Speak with an addiction professional to learn if contingency management is the right choice for you.




[1] http://www.sciencedirect.com/science/article/pii/S0376871600800083

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271179/

[3] http://www.ncbi.nlm.nih.gov/pubmed/17943878

[4] http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2006.01581.x/abstract

[5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2606605/

[6] http://psycnet.apa.org/journals/ccp/68/2/250/

[7] http://www.ncbi.nlm.nih.gov/pubmed/16445548

[8] http://ajp.psychiatryonline.org/article.aspx?articleID=174754

[9] http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-0


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