Contingency Management for Alcohol Addiction

Contingency management harnesses the power of motivation and incentives to promote changes in behavior. Using positive reinforcement, contingency management seeks to increase desired choices—like remaining sober—with strategic rewards.1 Flexible contingency management can also blend with other evidence-based treatment practices.1

In this article: 

What Is Contingency Management?

One of the challenges associated with addiction recovery is learning to deal with delayed gratification.1 Substance use activates the reward center in the brain intensely and instantaneously. The longer a person experiences the intense activation of substance use, the harder it becomes for them to remain motivated to seek out other meaningful rewards in their lives.1 Contingency management seeks to challenge this dysfunctional reward process and rewire the cognitive response to rewards.

Using interventions and rewards, contingency management for addiction treatment can help you focus on recovery.1 The strategic use of setting small and large goals can promote your success in achieving and maintaining sobriety, as well as your success in other treatment programs.1

Contingency management uses behavioral analysis principles and avoids using punishment to reduce unwanted behavior.1, 2 This approach instead relies on withholding rewards when people do not adhere to the established standards of the program.1

Behaviors rewarded in contingency management include:1

How treatment providers reward these behaviors can vary.2 The success or challenges you experience in achieving recovery-related goals may also influence access to rewards.1

How Is Contingency Management Applied to Addiction Treatment?

You can see the benefits of contingency management in addressing a variety of issues, clinical and personal.2 Clinicians have used this approach to treat several types of substance use concerns including:1, 2

  • Stimulant misuse
  • Opioid misuse and detox
  • Alcohol misuse
  • Nicotine misuse
  • Marijuana misuse
  • Benzodiazepine misuse
  • Cocaine misuse
  • Methamphetamine misuse

Each person has different treatment needs. If you receive treatment for a mental health disorder and a substance use disorder, you may benefit from contingency management interventions.2 If you have medical issues, this approach may help you stay compliant with your treatment plan to benefit your physical health needs.1, 2

Settings such as methadone clinics, housing shelters, intensive outpatient programs (IOP), group treatment settings, and even Veteran’s Affairs programs have successfully implemented contingency management programs.1, 3 Different programs adapt the types of rewards offered to meet the needs of the demographics they serve.1

Contingency management is often used in programs that meet housing needs, offer job skills training, and address behaviors that increase the risk of certain blood-borne illnesses.4, 5

Effectiveness for Addiction

Since contingency management primarily relies on external rewards, you may have concerns that the benefits only last as long as you receive rewards.6 When researchers compared contingency management in addiction treatment with motivational interviewing, contingency management alone had shorter lasting effects in the six months following treatment.6

A meta-analysis of several studies showed that contingency management had benefits that lasted longer than those from other evidence-based approaches.6 This analysis compared contingency management’s effects after a year with other treatments such as 12-step programs, cognitive behavioral therapy (CBT), and community-based IOP treatment. The approach that best motivates you may influence your success in a contingency management program.6

Consider how a combination of contingency management and other treatment approaches can promote your long-term recovery.

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What Are the Incentives in Contingency Management?

Contingency management programs offer unique ways of boosting your efforts at addiction recovery through different incentive methods.2

Talk with your provider about how you want to establish markers for success and incentives in a contingency management program. Striving for small changes can prepare you for the larger success achievable through this approach.1

Challenge perfectionism by rewarding gradual success.1 Small rewards for reducing your substance use can help you move toward full sobriety.1 This approach can then build toward greater incentives as you accomplish larger goals in your recovery process. You can maintain accountability by adjusting your access to incentives as you experience success or challenges in recovery.1

These tools serve as the foundation of the contingency management process. How providers use these techniques can vary.4, 6

Your provider may use vouchers that serve as tokens that you can redeem for items, goods, or other services.1 Your provider may offer different types of rewards you can redeem vouchers to receive. The value of these vouchers or number of vouchers you receive can increase as you complete more goals.1 If you do not reach a goal, your provider may have guidelines for how the value of vouchers reset. Some providers use a point system that functions in a similar way.

Some providers use prize drawing incentives in contingency management.1 In a “prize-based” approach, you may draw a slip of paper from a bowl or submit a ticket to a raffle for the chance to win rewards.2 The rewards may be goods, services, or items of monetary value. Alternatively, you may draw a slip of paper with a motivational message.1 The prize drawings may also operate as part of the point or voucher system. For example, you may receive more chances to win based on the number of vouchers you have earned.1

Research has shown that both incentive methods have similar success in promoting sobriety-related outcomes.4 Even though it takes time to earn rewards, this process can encourage you to keep striving for your goals in the long term.1

Is Contingency Management for Me?

Each person has their own needs in substance use recovery. Consider the unique factors in your life that may dictate your treatment needs and preferences. This information can influence how much a contingency management program may benefit you.

Treatment providers have offered contingency management for addiction treatment among:1, 3, 5, 7

  • People facing homelessness
  • Military veterans
  • Adolescents
  • People with infectious diseases
  • People who also have co-occurring mental health disorders

Some research has shown that contingency management combined with technology can promote recovery outcomes.1 For people not yet in recovery, contingency management offered via cell phone had noteworthy benefits in these studies.8

You may have challenges staying motivated for sobriety at the start of your recovery process. Contingency management can offer that first boost you need to make it through early recovery.1

Alternatively, if you have many logistical concerns impacting your life, contingency management may need to wait. Legal, financial, medical, and housing concerns may take precedence in your life at the start of treatment.9 Contingency management may not be appropriate when other pressing needs have not yet been addressed. Take inventory of your needs and your willingness to participate in a specific treatment program.

Contingency management can also work well alongside several evidence-based approaches to addiction recovery.1

Research has shown the following:

  • Case management and medication combined with contingency management can help people with special needs.1
  • The combination of CBT, motivational interviewing, and contingency management had noteworthy benefits for some people who sought treatment for cannabis use disorder.1, 10 Study participants reported these benefits at a one-year follow-up assessment after completing treatment.10
  • Community reinforcement approaches also focus on systems of rewards as a means of reducing and eliminating substance misuse.1 This approach combined with contingency management has demonstrated notable success in promoting addiction recovery.11

If you have specific needs beyond addiction treatment, creating a specialized and holistic approach to treatment can cover the gaps that contingency management alone may not address.1 Finding ways to maintain contingency management for longer periods of time can help enhance the lasting success of this approach.12

If you need help choosing a treatment program, reach out for support. Specialists can help you weigh out your options to make an informed choice as you begin recovery.

Find out if the rewards of contingency management can help you reach your health and wellness goals. Call [PHONE] today to speak with a treatment specialist about your recovery options.

Resources

  1. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: A guide for professionals. The Guilford Press.
  2. Petry N. M. (2011). Contingency management: What it is and why psychiatrists should want to use it. The Psychiatrist, 35(5), 161-163.
  3. Ruan, H., Bullock, C. L., & Reger, G. M. (2017). Implementation of contingency management at a large VA addiction treatment center. Psychiatric Services, 68(12), 1207–1209.
  4. Rash, C. J., Alessi, S. M., & Zajac, K. (2020). Examining implementation of contingency management in real-world settings. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 34(1), 89-98.
  5. Herrmann, E. S., Matusiewicz, A. K., Stitzer, M. L., Higgins, S. T., Sigmon, S. C., & Heil, S. H. (2017). Contingency management interventions for HIV, tuberculosis, and hepatitis control among individuals with substance use disorders: A systematized review. Journal of Substance Abuse Treatment, 72, 117-125.
  6. Ginley, M. K., Pfund, R. A., Rash, C. J., & Zajac, K. (2021). Long-term efficacy of contingency management treatment based on objective indicators of abstinence from illicit substance use up to 1 year following treatment: A meta-analysis. Journal of Consulting and Clinical Psychology, 89(1), 58-71.
  7. Stanger, C., & Budney, A. J. (2019). Contingency Management: Using incentives to improve outcomes for adolescent substance use disorders. Pediatric Clinics of North America, 66(6), 1183–1192.
  8. Getty, C. A., Morande, A., Lynskey, M., Weaver, T., & Metrebian, N. (2019). Mobile telephone-delivered contingency management interventions promoting behaviour change in individuals with substance use disorders: A meta-analysis. Addiction, 114(11), 1915–1925.
  9. Pfund, R. A., Cook, J. E., McAfee, N. W., Huskinson, S. L., & Parker, J. D. (2021). Challenges to conducting contingency management treatment for substance use disorders: Practice recommendations for clinicians. Professional Psychology: Research and Practice.
  10. Budney, A. J., Roffman, R., Stephens, R. S., & Walker, D. (2007). Marijuana dependence and its treatment. Addiction Science and Clinical Practice, 4(1), 4-16.
  11. Higgins, S. T., & Abbott, P. J. (2001). CRA and treatment of cocaine and opioid dependence. In R. J. Meyers & W. R. Miller (Eds.), A community reinforcement approach for addiction treatment (pp. 123–146). Cambridge, UK: Cambridge University Press.
  12. Petry, N. M. (2012). Contingency management for substance abuse treatment: A guide to implementing this evidence-based practice. Routledge/Taylor & Francis Group.
  13.  Cunningham, C., Stitzer, M., Campbell, A. N., Pavlicova, M., Hu, M. C., & Nunes, E. V. (2017). Contingency management abstinence incentives: Cost and implications for treatment tailoring. Journal of Substance Abuse Treatment, 72, 10-18, 134-139.

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