Contingency Management (CM) for Substance Abuse Treatment

Placement on the Continuum of Evidence Promising Download icon Download PDF
Target Population: 
Adolescents, Adults
Sector: 
Community-Based
Topic: 
Alcohol/Drugs/Tobacco
Military Sector: 
Veterans Affairs
Target Audience 

This program is for adolescents and adults who have substance use disorders.

Summary 

Contingency Management (CM) for Substance Abuse Treatment is a community-based program that is designed to promote behavior change in participants by offering rewards and incentives as reinforcers.

Evidence 

A number of randomized controlled trials conducted on the CM for Substance Abuse Treatment program have shown significant effects on drug abstinence in populations using cannabinoids, nicotine, alcohol, opiates, opioids, and stimulants.  Positive and significant outcomes were also found for treatment retention, weeks of consecutive abstinence, aftercare attendance, compliance with prenatal visits/care (i.e., for pregnant populations), adherence to treatment goals, and increased time until relapse.  Program evaluations measuring opiate use have shown sustained effects up to 1 year post-treatment; whereas, for other substances, the program has been shown to have sustained effects for up to 6 months post-treatment.

Components 

CM for Substance Abuse Treatment is often used as an adjunctive program to other substance abuse treatment interventions and focuses on altering participants' substance abuse behaviors by utilizing behavioral principles.  This program consists of three main parts.

  • Behavior targeted for change - Abstinence from substances, which is demonstrated by mandatory urinalysis or breathalyzer tests that come back negative, and adherence to treatment goals and meeting attendance expectations.
  • Reinforcers for the intended behavior - Provide money or vouchers that represent tangible items and can be redeemed at a later time.
  • Consequences for undesirable behavior - Eliminate reinforcers when participants submit substance-positive samples, do not attend meetings, or fail to comply with treatment goals.

CM programs can be adapted for diverse populations and audiences and can be applied to other areas, including weight loss, enhancing exercise, medication adherence, diabetes management.  The CM for Substance Abuse Treatment manual provides guidelines for creating a customized program.

Previous Use 

CM for Substance Abuse Treatment has been used widely across the United States since the late 1960s and has been implemented with Veterans.

Training 

This program is delivered by clinicians who have a doctoral degree or who are doctoral candidates.  Training is suggested and is available in a variety of formats.  Please contact the Contingency Management University of Connecticut Health Center using details in the Contact section for more information on training and costs.  

Considerations 

Considerations for implementing CM for Substance Abuse Treatment include recruiting clinicians; obtaining training for clinicians, if desired; acquiring participant buy-in and commitment; and understanding reinforcers will need to be purchased.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Implementation 

If you are interested in implementing CM for Substance Abuse Treatment, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Time 

Duration of this program varies and depends on several factors, such as needs of participants and requirements of the treatment program with which it is paired.

Cost 

Material costs vary based on program length and the reinforcers used.  The CM for Substance Abuse Treatment Manual is $48.56 as an eBook, $53.95 as a paperback book, and $195 as a harback book.  This manual provides a guideline to help determine the costs of implementation.  Please visit https://www.routledge.com/Contingency-Management-for-Substance-Abuse-Treatment-A-Guide-to-Implementing/Petry/p/book/9780415882897 for more information and to place orders.  

Evaluation Plan 

To move CM for Substance Abuse Treatment to the Effective category on the Clearinghouse Continuum of Evidence, at least one additional randomized controlled trial should be performed demonstrating positive effects lasting at least two years from the beginning of the program or at least one year from program completion.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Contact 

Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu

You may also contact the Contingency Management University of Connecticut Health Center by mail 263 Farmington Avenue, Farmington, CT 06030-3944, email cmrewards@uchc.edu, or visit https://health.uconn.edu/contingency-management/contact-us/

References
References - Used For Placement 

Budney, A. J., Higgins, S. T., Delaney, D. D., Kent, L., & Bickel, W. K. (1991). Contingent reinforcement of abstinence with individuals abusing cocaine and marijuana. Journal of Applied Behavior Analysis, 24, 657-665. doi:http://dx.doi.org/10.1901/jaba.1991.24-657

Chutuape, M. A., Silverman, K., & Stitzer, M. (1999). Contingent reinforcement sustains post-detoxification abstinence from multiple drugs: A preliminary study with methadone patients. Drug and Alcohol Dependence, 54, 69-81. doi:http://dx.doi.org/10.1016/S0376-8716(98)00144-6

Corby, E. A., Roll, J. M., Ledgerwood, D. M., & Schuster, C. R. (2000). Contingency management interventions for treating the substance abuse of adolescents: A feasibility study. Experimental and Clinical Psychopharmacology, 8, 371-376. doi:http://dx.doi.org/10.1037/1064-1297.8.3.371

Elk, R., Mangus, L., Rhoades, H., Andres, R., & Grabowski, J. (1998). Cessation of cocaine use during pregnancy: Effects of contingency management interventions on maintaining abstinence and complying with prenatal care. Addictive Behaviors, 23, 57-64. doi:http://dx.doi.org/10.1016/S0306-4603(97)00020-8

Helmus, T. C., Saules, K. K., Schoener, E. P., & Roll, J. M. (2003). Reinforcement of counseling attendance and alcohol abstinence in a community-based dual-diagnosis treatment program: A feasibility study. Psychology of Addictive Behaviors, 17, 249-251. doi:http://dx.doi.org/10.1037/0893-164X.17.3.249

Higgins, S. T., Wong, C. J., Badger, G. J., Ogden, D. E. H., & Dantona, R. L. (2000). Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up. Journal of Consulting and Clinical Psychology, 68, 64-72. doi:http://dx.doi.org/10.1037/0022-006X.68.1.64

Iguchi, M. Y., Belding, M. A., Morral, A. R., Lamb, R. J., & Husband, S. D. (1997). Reinforcing operants other than abstinence in drug abuse treatment: An effective alternative for reducing drug use. Journal of Consulting and Clinical Psychology, 65, 421-428. doi:http://dx.doi.org/10.1037/0022-006X.65.3.421

Kamon, J., Budney, A., & Stanger, C. (2005). A contingency management intervention for adolescent marijuana abuse and conduct problems. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 513-521. doi:http://dx.doi.org/10.1097/01.chi.0000159949.82759.64

Petry, N. M., Martin, B., Cooney, J. L., & Kranzler, H. R. (2000). Give them prizes and they will come: Contingency management for treatment of alcohol dependence. Journal of Consulting and Clinical Psychology, 68, 250-257. doi:http://dx.doi.org/10.1037/0022-006X.68.2.250

Petry, N. M., Tedford, J., Austin, M., Nich, C., Carroll, K. M., & Rounsaville, B. J. (2004). Prize reinforcement contingency management for treating cocaine users: How low can we go, and with whom? Addiction, 99, 349-360. doi:http://dx.doi.org/10.1111/j.1360-0443.2003.00642.x

* For a full list of references please contact the Clearinghouse

*Resources and associated costs reflect those identified at the time of fact sheet publication.