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How Does Contingency Management Work?

Jessica McConnan By Jessica McConnan, M.A. on December 2, 2015

Contingency management is a therapeutic treatment option for drug and alcohol addiction that, according to the National Institute on Drug Abuse, “uses positive reinforcement to encourage abstinence from drugs.” Also called motivational incentives, contingency management is a popular treatment option, especially for the treatment of addiction to certain substances of abuse.

Restructuring Reward Pathways

As stated by the NIDA, contingency management is often used to treat alcohol, stimulant, opioid, marijuana, and nicotine addiction and abuse. This treatment can be very effective because it helps to restructure the reward pathways in the brain, which are often changed for the worse by consistent drug abuse. Over time, a person’s brain begins to expect the drug, to need it in order for the individual to feel good, and this change can be very difficult to resolve. Fortunately, contingency management helps in this instance.

Contingency management works by creating a relationship between the counselor and the patient in which the patient is given reinforcements as a reward for their abstinence from substance abuse. According to the National Institute on Alcohol Abuse and Alcoholism, “In an early study of contingency management in alcoholism treatment, Miller (1975) found that by providing tangible reinforcers to public inebriates contingent on negative breath-alcohol tests, researchers could effectively reduce public inebriation.”

The treatment also helps to reduce the abuse of other substances, and once the patient and counselor are able to find a beneficial routine in which the patient is being offered reinforcements that interest them, true change can be made to the reward pathways of the brain, allowing for serious recovery as the patient learns to desire something besides these dangerous substances.

Offering the Right Reinforcement

The patient must be able to receive the type of reinforcement that will help them refuse substance abuse and stay sober. If the patient has a true desire for the reinforcement being offered, it will be easier for them to fight the temporary reward they would receive in abusing substances for the more beneficial reward of their reinforcement.

There are two different types of rewards given in contingency management treatment: voucher-based and prize incentives. In voucher-based reinforcement, “the patient receives a voucher for every drug-free urine sample provided” (NIDA 2). These vouchers have monetary value and can be good for an exchange of services. Some allow patients to get food, clothing, and other necessary items while others can allow the patient to do fun or desirable things like go to the movies, etc. These vouchers must always provide a good or service consistent with a drug-free lifestyle. In the unfortunate event of a positive drug test, the next voucher the patient receives will return to the lowest possible level.

The prize incentives version is similar to the voucher-based system, but instead, patients are able to win cash. Those who provide a clean drug test are submitted into a drawing to win monetary prizes, often between $1 and $100. Attending sessions and participating in other treatment activities also earns patients more slips in the drawing. This can be very beneficial as well and can be helpful to those patients who are in especially difficult situations financially.

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