Contingency Management

Contingency management can be a controversial topic in addiction treatment circles. Some believe this “carrot and stick” approach works as part of behavioral therapy and some do not.

This article explains the concept of contingency management and explores whether it is an effective component of a holistic addiction treatment program.

What is Contingency Management?

Contingency management in rehab is a type of behavioral conditioning tied to a system of penalties and rewards. It seeks to teach substance users that their behaviors are tied to negative consequences but that by changing their activities, they can have a better life. One example of this type of operant conditioning is to drug test the individual during the recovery process. If the patient tests negative for drugs or alcohol, the program could provide them with a reward, which could be a voucher for a service or even a cash prize.

Interestingly, there is a form of contingency management built into the work that parents do with their children and teenagers. If children clean their rooms, they may get an allowance. If teens do not do their homework, video games may be taken away.

The idea, of course, is that rewarded behaviors are more likely to continue while activities that have a punitive outcome would be reduced. Behaviors that are ignored, and therefore not rewarded, will also reduce over time.

If you think about it, the effect of opioids on the brain also has a contingency management effect; taking drugs stimulates neurochemicals like dopamine to release into the bloodstream. This reward is a feel-good that is highly addictive both physically and mentally. It is this reward that Washington State addiction treatment seeks to circumvent.

How Effective is Contingency Management?

The National Institute on Drug Abuse suggests that research documents the success of Contingency Management for substance users. For instance, studies conducted in both methadone programs and psychosocial counseling treatment programs demonstrate that incentive-based interventions are highly effective in increasing treatment retention and promoting abstinence from drugs.

There are two primary types of rewards under Contingency Management behavioral counseling programs:

1. Vouchers are used primarily with adults who abuse drugs like heroin or other opioids. For every drug-free urine test, a voucher is given. Vouchers can be exchanged for goods and services.
2. Cash prizes are used in place of vouchers and are awarded for negative drug tests or attending specific counseling sessions.

Contingency management can be used in addiction treatment programs along with cognitive-behavioral therapy, medication-assisted therapy, and other individual and group counseling. In the same way that touching a hot stove can teach a toddler avoidance techniques, or a teenager’s good report card can be rewarded, contingency management has been effective as a tool to teach substance users behaviors that should be replicated – and ones that should be avoided at all costs.

While you will see contingency management in Washington State addiction treatment, you will also find it anywhere behavioral modification techniques are used, such as schools, the military, and in prisons. In all of these settings, these techniques are an effective way to teach new behaviors. To find out more about these and other therapeutic techniques, contact us today!