What Is Contingency Management In Addiction Treatment?

Stimulant use disorders are a common, serious issue in the U.S. today. Contingency management is just one of the treatment options available to help people with addictions to cocaine or other stimulants achieve recovery.

Addiction is considered a chronic and relapsing disorder. But this does not mean that addiction is hopeless or untreatable. In fact, most people (72.2%) who have ever had a substance use disorder see themselves as being in recovery, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). And many treatment options are available to support those who have an active SUD, no matter the particular substance or substances that are involved.

Contingency management (CM) is one of these proven treatment options. It works by incentivizing people in treatment to make positive choices through tangible rewards. Not only is CM widely considered an effective treatment option for many different forms of SUD, but it is also considered the most effective treatment for stimulant use disorders in particular.

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How Contingency Management Works

When a person misuses a drug of abuse like alcohol or opioids, dopamine immediately floods their central nervous system. Over time, this natural feedback effectively trains the body and the mind to crave those substances, despite the harm they may cause in a person’s life. This effect can be particularly strong when it comes to fast-acting and energetic stimulant drugs like cocaine and methamphetamine.

Contingency management works by taking advantage of a similar feedback process. First, clients in either outpatient or inpatient treatment programs are given a clear goal, like “do not use cocaine.” Then they are given regular drug testing over a period of weeks or months, or interviewed to discuss whatever other goals they may have been working towards.

If the client has had a good outcome, like a negative drug test, they are given a prize or a voucher to reinforce that outcome. If they had a bad outcome, they discuss what happened with a counselor and do not receive a reward. Then they are given another chance the following week, with CM programs recommended for at least 12-week run times or longer.

While CM may seem simple, the structured feedback and tangible rewards it offers can help people with SUD to stop using substances. CM can also be used to help people meet a wide variety of related goals besides abstinence. Examples include taking one’s medication, attending treatment sessions, following a good sleep schedule, and more.

Variations Of Contingency Management

Contingency management programs come in two main types: prize systems and voucher systems.

In a prize system, clients draw a random slip of paper from a prize bowl, earning rewards like cash or electronics. These vary in value, from a single dollar award all the way up to “grand prizes” of several hundred dollars. After each visit, prizes are replaced, meaning that clients have the same motivation and the same odds of success each visit.

Clients may even be given extra draws the more weeks of success they have in a row, encouraging them to double-down on their success week after week.

In voucher systems, clients are given a schedule of rewards including things like cash prizes, gift cards, electronics, vouchers for local services, and more. Each good result progresses clients down this schedule, providing increasingly desirable rewards week after week, but resetting back to the first week’s prize if their goal isn’t reached.

Is Contingency Management Effective?

CM is an evidence-based treatment endorsed by a variety of different healthcare experts, including the U.S. Department of Health and Human Services. It shows special promise when it comes to treating stimulant use disorders, as no medications are available to treat these addictions in the same way that medication-assisted treatments have been developed for opioid use disorders and alcohol use disorders.

CM is not without controversy, however, as some have compared it to gambling and others see it as simply paying people in recovery to make the healthy choices they should already be making for themselves. Others have criticized CM as a waste of funds, or even as a form of enablement, as CM rewards can be used to purchase illicit drugs if and when a person relapses.

Nevertheless, CM has over 30 years of evidence and endorsements behind it. In fact, according to a meta-analysis published in 2013, “Contextual Factors in Addiction,” contingency management increased the effectiveness of clients’ treatment considerably, increasing the percentage of positive treatment episodes from 39% to 61% in drug use disorder treatment programs.

What Other Treatment Options Do I Have?

Contingency management is only one treatment option among many that providers can use, and it can fit neatly into a personalized treatment plan made up of other evidence-based treatment elements including but not limited to the following:

If you would like to learn more about these and other treatment services, and how Bedrock Recovery Center can support you with a personalized addiction recovery pathway, please contact us today.

  1. Johns Hopkins Bloomberg School of Public Health - Contingency Management for Treatment of Stimulant Use Disorder and Strategies to Address Polysubstance Use https://opioidprinciples.jhsph.edu/contingency-management-for-treatment-of-stimulant-use-disorder-and-strategies-to-address-polysubstance-use/
  2. National Institute on Drug Abuse (NIDA) - Drug Misuse and Addiction https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
  3. U.S. Department of Health and Human Services (HHS) - Contingency Management for the Treatment of Substance Use Disorders: Enhancing Access, Quality, and Program Integrity for an Evidence-Based Intervention https://aspe.hhs.gov/sites/default/files/documents/72bda5309911c29cd1ba3202c9ee0e03/contingency-management-sub-treatment.pdf

Written by Bedrock Recovery Center Editorial Team

Updated on: November 19, 2024

© 2025 Bedrock Recovery Center | All Rights Reserved

* This page does not provide medical advice.

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