In thecontingency management group, individuals earned at least one draw with achance of winning a prize ranging from US$1 to 100 in value for eachstimulant-negative sample submitted, and number of draws earned increased withweeks of consecutive abstinence. About half of the sample were recruited frompsychosocial (non-methadone) and half from methadone clinics. In thepsychosocialclinics,3contingency management significantly enhanced retention in treatment, with 49%of the contingency management group completing 12 weeks of treatmentv. The mean number of weeks ofconsecutive abstinence from stimulants was 4.4 for those assigned tocontingency management v. 2.6 for those assigned to standard care.The percentage of individuals who sustained stopping duloxetine cold turkey stimulant abstinence throughoutthe full 12 weeks was nearly 4 times greater for the contingency managementcondition (18.7% v. 4.9%). In the methadone arm of thestudy,4 durations ofcontinuous cocaine abstinence achieved were also significantly enhanced in thecontingency management condition relative to the standard care condition, withmeans of 2.8 v. 1.2 weeks of abstinence respectively.
Most commonly, contingency management has been successfully used in smoking reduction programs for pregnant women who are receiving treatment for drug abuse and for pregnant women who are in treatment for alcohol or cocaine dependence. Contingency management for women can effectively utilize personal hygiene, household, or children’s items as “prizes” for attaining or sustaining abstinence, based on urine test results. Contingency management interventions have also been combined with brief motivational interventions within the context of case management services for pregnant women. Contingency management refers to the systematic provision of incentives and/or disincentives for specific behaviors for the purpose of modifying those behaviors (Petry, 2000). We identified five studies of contingency management (Table 8), four with experimental designs and one quasi-experimental.
While reinforcers are commonly used in health care to increase a targeted behavior (eg, gift cards for completing a health assessment), the recommended frequency (twice weekly) and magnitude of CM reinforcers is unique. Historically, funding for CM programs has relied on grants, donations, and funding from federal sources. Currently, the Substance Use and Mental Health Services Administration (SAMHSA) allows grantees to spend up to $75 per patient for CM incentives, although there is limited evidence for the efficacy of this amount. Contingency management (CM) is an effective behavior change technique commonly used to treat substance use disorders (SUDs).
Gender-Specific Treatments for Substance Use Disorders
Given that it is widely accepted, and has been recognized for decades, that drugs of abuse function as potent positive reinforcers, a procedure designed specifically to decrease the drug’s reinforcing efficacy, and hence the control the drug will exert over an individual’s behavior, has much to recommend it from a theoretical framework. Contingency management refers to a type of behavioural therapy in whichindividuals are ‘reinforced’, or rewarded, for evidence ofpositive behavioural change. These interventions have been widely tested andevaluated in the context of substance misuse treatment, and they most ofteninvolve provision of monetary-based reinforcers for submission ofdrug-negative urine specimens. A way to reduce the costs of CM is to provide only a proportion of the behaviors with a tangible reinforcer.
- Contingency management was included as a recommended treatment in guidelines published by the National Institute for Health and Clinical Excellence in the United Kingdom.
- However, there is a ‘substantial proportion’ of addicts who do not respond to contingency management as a form of therapy (Carroll and Onken, 2005).
- Different associations may also relate to whether reinforcers are provided for attempting a task, finishing it, or reaching some threshold of performance (Cameron et al., 2001).
- Historically, funding for CM programs has relied on grants, donations, and funding from federal sources.
- Screening and brief interventions for alcohol use have been reimbursed by commercial insurance, Medicare, and Medicaid for years (Neighbors, Barnett, Rohsenow, Colby, & Monti 2010; Bray et al., 2014; SAMHSA, 2016).
Contingency management might also be helpful for individuals with co-occurring substance use disorders, who are at elevated risk of smoking-related morbidity and mortality. Research in residential treatment patients, methadone-maintained opiate-dependent patients, and in the Veteran’s Administration hospital population demonstrates that contingency management can reduce smoking and promote abstinence in this group. Application of this intervention to improve adherence with smoking cessation medications is another area of interest. Despite promising results, this literature remains relatively small, in part because of technological limitations on detecting smoking via breath or urine tests in the flakka wikipedia context of contingency management (see Contingency Management for a more detailed discussion). A vast amount of empirical evidence indicates the efficacy of contingencymanagement for treating substance use disorders. For example, in multicentrestudies conducted throughout theUSA,3,4over 800 individuals with stimulant misuse from 14 clinics were randomlyassigned to standard care as usual plus twice-weekly urine sample testing, orthat same treatment plus contingency management for 12 weeks.
Contingency Management for the Treatment of Substance Use Disorders
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Clinical Course
In one outpatient treatment program, alcohol-dependent patients earned the chance to draw from a bowl and win prizes of varying magnitudes for submitting negative breath-alcohol samples and completing steps toward their treatment goals (Petry et al., 2000). The prizes available ranged from $1 prizes (choice of a bus token or fast-food coupon), $20 prizes (choice of a personal tape player, watch or phone card) and $100 prizes (choice of television or stereo). Chances of winning were inversely related to prize costs, such that chances of winning a $1 prize were approximately 1 in 2, while chances of winning a $100 prize were 1 in 250. This intermittent schedule of reinforcement may be an inexpensive expansion of vouchers, as average cost per client was under $200. The beneficial effects of this technique were replicated in cocaine-abusing methadone patients (Petry and Martin, in press).
Regular articleContingency Management: New Directions and Remaining Challenges for An Evidence-Based Intervention☆
Contingency management is a highly effective treatment for substance useand related disorders. However, few psychiatrists are familiar with thisintervention or its application to a range of patient behaviours. This paperdescribes contingency management and evidence of its efficacy for reducingdrug use. A series of studies demonstrated that CM is efficacious in retaining patients in treatment and reducing substance use. Higgins et al. (1993) randomly assigned cocaine-dependent outpatients to 12-step-oriented treatment or a CM treatment in which they received individual behavioral therapy in conjunction with vouchers every time they provided a drug-free urine specimen.