Among the numerous forms of treatment available for substance abuse and addiction, some are perhaps lesser-known to the general public. This includes contingency management (CM), which is a type of treatment that uses rewards and incentives to change negative behaviors into positive ones.
When it’s used alongside other therapies, contingency management has proven to be effective at helping individuals stay sober and increase participation in treatment programs. If you’re curious about contingency management approaches for yourself or someone you love, the article below can help.
What Is Contingency Management?
Contingency management (CM) is an evidence-based behavior modification technique that uses incentives or rewards for motivation. These techniques have proven to be useful for substance abuse treatment in terms of encouraging and sustaining abstinence. While contingency management can be effective on its own, it is usually delivered alongside other treatments such as cognitive-behavioral therapy (CBT) or medication management.
The main principle behind CM is that if a behavior is reinforced or rewarded, it is more likely to be practiced in the future. When it comes to substance abuse or addiction, CM involves creating new kinds of behaviors and pathways towards healthy everyday life choices. This can involve different CM methods such as cash incentives, vouchers, prizes, etc.
For example, some rehabilitation programs require weekly drug-free urine samples. CM may involve providing supermarket vouchers as a reward for submitting these weekly samples. The idea behind this technique is that rather than utilizing punitive or negative reinforcement means, a person is encouraged to stay abstinent or follow the protocols of treatment through rewards and incentives.
CM Variations
CM has proven to be effective at helping individuals stay sober, remain in rehab, and improve participation in treatment. The two main variations of CM consist of voucher-based reinforcement (VBR) and prize incentive contingency management.
VBR
Voucher-based reinforcement is variable as these can be converted into other valuable monetary assets such as vouchers for food, clothing, recreation, or entertainment. When using VBR, the value of the voucher is low to start with, but then it increases in value the more a person adheres to the positive behaviors. This increase in value can help a person feel a greater desire and sense of accomplishment when they achieve each goal. The benefit of VBR-based incentives is that they help promote an active, drug-free lifestyle.
Prize Incentives
Prize incentives are similar to VBR; however, the difference is that a person is eligible to win cash prizes instead of vouchers. Again, the value of the incentive usually starts out low and then gradually increases as the person commits to the positively reinforced behavior. These behaviors could be anything from submitting urine samples, taking medications, participating in group therapy, or avoiding substance temptations. Critics of this approach argue that it can promote gambling behavior; however, no research supports this.
History of Contingency Management
Researchers began exploring the use of contingency management for alcoholism in the 1960s. During this time, other treatment approaches were being explored alongside CM while utilizing similar principles. This involved promoting sober social activities and enhancing coping skills through interventions like the Community Reinforcement Approach (CRA), which helped people find alternative ways to meet their emotional and social needs.
In the 1990s, studies began to demonstrate the effectiveness of CM for increasing abstinence among people addicted to cocaine. Since then, CM has been used widely not only for stimulant abuse but for other substances as well. While CM is rarely delivered as a standalone treatment, it can often be found as an integrated method with other treatment modalities.
What Happens During Contingency Management
Contingency management techniques can be applied in different therapeutic settings such as one-on-one counseling or group therapy. While approaches, methods, and styles may differ, what is universal about CM is that it always involves the use of rewards and incentives.
While CM can be led by a mental health professional, it doesn’t always have to be delivered in a clinical setting. For example, leaders of self-help groups or parents of teenagers can use contingency management strategies to help their loved ones through addiction.
Courts might also use CM strategies to reduce recidivism in individuals who have alcohol-related offenses. Rather than sending them to jail, a judge can ask them to live at home while providing incentives to stick to the rules. Clients can then earn greater and greater rewards as they progress through the court-ordered program.
CM can also be used to encourage participation in other types of addiction or mental health treatment.
Basic Principles of Contingency Management
The main goal of CM is to behave consistently in positive and empowering ways, even in the face of difficult or challenging circumstances. In many ways, CM can teach a person that it is possible to overcome temptations through the power of their own will. As well as this overarching goal, there are some basic principles that inform CM:
1. Target Behavior
The first task is to identify and address the target behavior. Whether it’s abstinence, participation in an activity, or compliance with treatment, the first aim is to target the behavior and then change it to a positive outcome.
2. Choice of Target Population
CM needs to be targeted to the right people at the right time. For example, some clients may not need or want to participate with CM because they have enough motivation of their own to progress their recovery. CM is, therefore, most effective for new clients or those who have been unsuccessful with other therapies in the past.
3. Choice of Reinforcer
When using CM, it’s vital that the right incentive be given (known as the reinforcer). If a patient is rewarded with an item that has no value to them, it will not be effective. Therefore, it’s important that the therapist or person leading CM identify the correct reinforcer that will be realistic and desirable to the client.
4. Incentive Magnitude
As well as identifying the correct incentive, CM programs should also apply the right magnitude. For example, if a person has a history of extreme substance use with multiple relapses, they may need an incentive of higher magnitude, such as an item that is more expensive. While CM programs will naturally be limited by budgets and resources, it is important to know what level of incentive the individual requires. This can be assessed by evaluating a person’s:
- Previous substance use or addictions
- Previous success with recovery (if any)
- Strength of social and family support
- Previous response to rewards
5. Frequency of Incentive Distribution
The frequency of giving the incentive is another important element of CM. Some programs may reinforce the desired behavior each time it occurs, while others may provide it at specific rates or times. The ideal rate will be determined by the specific needs of each client.
6. Timing of Incentive
The timing of an incentive is also just as important as the frequency. Giving a reward to someone two days after they’ve completed the behavior, for example, might not lead to the right outcome. Usually, the best time to give a reward is immediately after the behavior so that the person can make strong associations between the reward and their actions.
7. Duration of intervention
The duration of the CM is another vital element to consider. If the goal is sobriety, the therapist or person leading the CM will need to evaluate how long the incentives should be given. Ultimately, the goal is to encourage the person to become independent and generate their own motivations rather than becoming reliant on the incentives provided. The duration can have a big effect on whether a person relapses.
Benefits of Contingency Management
There are many benefits to this kind of treatment approach. These include:
- It’s readily available: many therapists are trained in CM, and it is widely practiced.
- Insurance companies usually cover services since it is regarded as a beneficial treatment.
- It’s safe and low risk: there are few dangers or harms associated with this type of treatment.
- It promotes positive reinforcement rather than negative reinforcement, which can minimize a person’s feelings of guilt or shame.
Contingency Management & Treatment
As mentioned above, CM is not usually delivered as a standalone treatment. It is usually provided in combination with other therapies to provide a well-rounded way to help a person achieve their desired outcomes. Some of the treatments that can be delivered alongside CM include:
- Cognitive-behavioral therapy (CBT)
- Medication management or medication-assisted treatment (MAT) such as Suboxone or methadone
- Medication maintenance programs for people in recovery
- Motivational interviewing
Resources
If you or a loved one are struggling with substance abuse, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
Key Sources
National Institute on Drug Abuse (NIDA). (2018). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine). https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/contingency-management-interventions-motivational-incentives.
Petry, N. (2011). Contingency Management in Addiction Treatment. https://www.psychiatrictimes.com/view/contingency-management-addiction-treatment.
Recovery Research Institute. (n.d.). Contingency Management (CM). https://www.recoveryanswers.org/resource/contingency-management.
Medical Disclaimer
At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.
We provide our readers with factual, evidence-based content concerning the causes and nature of addiction, as well as available treatment options. However, this informative content is intended for educational purposes only. It is by no means a substitute for professional medical advice, diagnosis, or treatment. With regard to any addiction-related health concerns, you should always seek the guidance of a qualified, registered physician who is licensed to practice medicine in your particular jurisdiction. You should never avoid or delay seeking professional health care advice or services based on information obtained from our website. Our authors, editors, medical reviewers, website developers, and parent company do not assume any liability, obligation, or responsibility for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a result of the material presented on RehabAid.com.