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What is Contingency Management?
You may have heard the term, “contingency management” as it refers to aspects of a treatment center or program, or perhaps even as it relates to effective parenting. The term itself refers to a set of behavioral principles that are based upon the idea that behaviors that are rewarded are more likely to recur, or even increase in frequency, and seeks to capitalize on this truth to shape desired behaviors.
Think back to your understanding of how we learn and recall that there are four basic principles of shaping behavior: positive reinforcement, negative reinforcement, positive punishment, and negative punishment. For the purposes of this article, we will focus on positive reinforcement, as this is well-known to be the most effective long-term motivator of behavior that carries with it less relational risks of increasing avoidance, escape or revenge-seeking behaviors.
To a child, this means receiving praise, a sticker, or a small token for a job well done: cleaning up after themselves, learning to use the toilet, or playing nicely with siblings. This strategy works to the extent that the child finds the prize rewarding, thus when applying the principles to adults in treatment for substance abuse, it tends to be monetary-based rewards that inspire behavioral change.
Research confirms the effectiveness of these techniques in the treatment and recovery community in providing incentives for sobriety and other desired behaviors. Most often the rewards given are vouchers that can be traded in for goods and services or the opportunity to win prizes. Such tangible reinforcements can be highly effective to reward positive behaviors such as negative drug screens, encouraging timely attendance and participation, and adherence to medications throughout the treatment program.
Studies in both methadone programs and psychosocial counseling treatment programs indicate the effectiveness of this model also in increasing treatment retention. This includes findings from one particular study, where the likelihood that individuals in psychosocial rehabilitation completed all 12 weeks of treatment was 14% greater when offered contingency management, and abstinence was obtained at a greater rate of 18.7% compared to 4.9% of the standard care group. Similar findings were found with individuals offered contingency management while engaged in methadone maintenance treatment.
There are two main methods of reinforcement that have been studied in these treatment environments that are known to show positive effects, voucher-based reinforcement, and prize incentives.
As described above, voucher-based reinforcement is built on the foundational agreement that positive, abstinence-reinforcing behaviors will be rewarded, and works well for individuals who are seeking treatment for the abuse of opioids, stimulants, or both. Those in treatment will receive a voucher for every negative drug screen that can be exchanged for food, items, movie passes or other goods, activities or freedoms that are representative of a lifestyle in pursuit of sobriety. The value associated with the vouchers begin with a nominal amount and gradually increase as the length of time with negative results accrue, and resets upon a positive result.
Similar to the provision of vouchers is the use of prize incentives of cash rather than vouchers. Under this model, negative drug screens earn participants the ability to draw from a pool for the chance to win a cash prize between $1 and $100. As with the vouchers, additional positive behaviors will be rewarded with a chance to draw, including community involvement, completing homework assignments, timely attendance, and significant contributions to the recovery community. Opportunities to draw increases with each consecutive negative drug screen, and as with the vouchers, is reset when the participant deviates from their recovery goals.
As contingency management is a strategy that we use at Riviera Recovery, we think it’s important to explain the theory and rationale for our clients, their families, and anyone considering a sober housing environment that is set upon helping you succeed. Give us a call today to learn more about how we support our residents!