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Beach House Recovery Center » Blog » What Is Contingency Management and How Is It Used in Addiction Treatment?
When you or a loved one enters treatment to overcome addiction, you want the best treatment available, one that’s evidence-based to be effective, and that offers the best prospects for a drug-free recovery. In connection with drug and alcohol rehab, one approach that may be used is contingency management (CM). While you may have heard of CM, you may not be familiar with the specifics of how it is used in addiction treatment.
The simple definition of contingency management is reinforcing or rewarding a desired behavior. Considered relatively new in the field of substance abuse, CM is a form of behavioral therapy. CM “draws upon classic behavior modification theories” and includes the specification of a behavioral outcome that can be objectively measured.
An article published in Alcohol Research & Health states that CM is “the systematic reinforcement of desired behaviors and the withholding of reinforcement of punishment of undesired behaviors, is an effective strategy in the treatment of alcohol and other drug (AOD) disorders.”
When used in conjunction with addiction treatment, CM aims to motivate the addict to perform or engage in specific activities or adopt certain proactive behaviors. Reinforcement is a key term in contingency management, and the purpose for using CM in treatment for substance use disorder (SUD) is to help motivate and encourage pro-recovery behavior. This includes attending sessions, remaining abstinent, working towards specified career or vocational, educational, or social goals.
CM also involves the opposite of rewards, or consequences, for not complying with desired behavior or abandoning goals (including skipping treatment sessions, returning to drinking or drug use). This is known as operant conditioning.
Studies on CM and its use in addiction treatment and recovery have found that rewards work better for long-term effective sobriety than punishments. Thus, CM strategies have continually evolved to include the types of incentives and motivational enticements that fare better in treatment completion and long-term abstinence.
Examples of the types of reinforcements provided include incentives for:
Given that the pull of motivation to do something (in exchange for some type of reward) is more effective in addiction treatment than punishment for failure to comply, there is no single reward that universally generates enthusiasm and proactive behavior. Researchers continue to test several types of rewards or incentives to gauge their effectiveness with certain populations and/or in the treatment of specific addictions.
Vouchers are an example of contingency management reward. Yet, the vouchers may be for distinctly different rewards. For example, a voucher may consist of movie tickets, a spa day, or some other form of free goods and services. Cash is another reward or incentive that motivates behavior compliance, at least initially. This type of incentive is particularly attractive to those with limited finances. The long-term use of incentives, however, does not result in continued proactive behavior. The most effective use of CM is in the early part of treatment, to give the recovering addict the opportunity to gain self-confidence participating in pro-recovery behavior and activities. The idea is that treatment, including psychotherapy (individual and group), different treatment modalities, educational instruction, lifestyle modification counseling, evidence-based and recovery-oriented therapies, participation in 12-Step and self-help groups, recreational and leisure activities and creating a relapse prevention plan provide a solid foundation in recovery so that the addict can become internally motivated to remain abstinent and engage in proactive recovery behavior.
A 2015 study published in the journal Drug and Alcohol Dependence found that low-cost CM cash incentives, when coupled with outpatient reinforcement-based treatment for substance abuse increased treatment attendance, treatment session attendance and continuing treatment utilization in the subsequent month, compared with patients receiving only reinforcement-based treatment. Participants were given $10 to return to treatment the day after intake assessment, and $15 for attending treatment on the fifth treatment day.
Researchers found that the use of vouchers or prizes in contingency management for cocaine- or heroin-dependent outpatients receiving substance abuse treatment in community treatment centers remained longer in treatment and experienced greater verified periods of abstinence than patients receiving standard treatment alone. Thus, the study confirmed that vouchers and opportunity to win prizes are equally effective for compliance with abstinence goals and for long-term positive treatment outcomes.
According to clinical research trials, the use of CM in conjunction with addiction treatment for alcoholism and illicit drug use has proven effective in reducing drug use, improving compliance in taking prescribed medications, in remaining in treatment, and promoting participation in other treatment-related goals, including employment. Studies also found that using various reinforcers across different populations and targeting various behaviors “generally improves outcomes relative to comparison treatment.”
A 2018 study concluded that CM interventions both motivate and maintain drug abstinence by providing the drug user with earlier, more salient and more predictable positive consequences for abstaining from drugs.
A meta-analysis of study findings in 2006 found that CM is “among the more effective approaches to promoting abstinence during the treatment of substance use disorders,” by improving clients’ ability to remain abstinent and paving the way for them to more fully experience the other components of clinical treatment.
If you or a loved one is seeking addiction treatment from a trusted rehab facility that employs evidence-based practices, please contact one of our Beach House admissions counselors today.
Whether you’re researching for yourself or a loved one, Beach House can help. We understand that this is a serious time in your life and that the treatment center you choose matters. We want you to feel comfortable and empowered to make the right decision for yourself, a friend, or a family member. This is why a counselor is waiting and available to answer your questions and help put your mind at ease regarding the next steps. Many of the staff at Beach House have walked in your shoes. If you feel you’re ready or want more information about how to help a loved one, we can help today. You can also learn why we are voted the #1 rehab for addiction treatment in Florida.
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