Contingency Management: How Rewards Help During Addiction Recovery

Contingency management (CM) is an incentive-based form of behavioral therapy. It rewards therapy clients for meeting treatment goals, often with a small prize or other financial incentive. 

Studies show this behavioral treatment, also known as “motivational incentives,” can be beneficial in the treatment of various substance use disorders, including opioid addiction.

Although historically controversial, the successful use of this treatment for addiction has gained greater attention as the number of drug overdose deaths continues to climb.

What Is The Goal Of Contingency Management?

The goal of contingency management is to deter the use of addictive substances, like cocaine, meth, and opioids — and promote positive behaviors, like attending therapy.

In essence, the goal is to make continued sobriety, or addiction recovery, more appealing than the use of a former substance of abuse by utilizing an incentive-based treatment approach.

How Does Contingency Management Work?

Contingency management treatment is based on the principle of operant conditioning, which proposes that a person’s behavior is shaped by its consequences — positive or negative.

CM programs offer positive reinforcement, such as prize-based incentives, for meeting goals or milestones within a substance abuse treatment program.

Examples of prize incentives might include:

• gift certificates
• candy
• cash
• vouchers that can be used to buy food, or other goods/services

Contingency management is often used alongside other evidence-based treatments. For example, counseling, medication for opioid use disorder, and behavioral therapy.

What Health Conditions Does Contingency Management Treat?

Contingency management has been studied as a treatment for various substance use disorders:

• cocaine use disorder 
• methamphetamine use disorder
• opioid use disorder
• alcohol use disorder
• marijuana dependence
• benzodiazepine addiction

Its use for treating addiction to stimulants, like meth and cocaine, has been a particular area of interest.

That’s largely because there are no FDA-approved medications shown to effectively treat illicit drug use disorders.

Examples Of Contingency Management Interventions

Generally, contingency management behavioral interventions are offered in one of two ways, although how they operate in practice may differ between treatment providers:

Voucher-Based Reinforcement

Using this type of CM treatment approach, clinicians reward those who attend treatment, or meet certain treatment goals, with a voucher that has monetary value.

Over time, the value of that voucher may increase with continued adherence to your treatment plan.

Contingency Management With Prize Incentives 

Prize incentives may also be awarded to treatment clients using what’s known as a fishbowl method. 

How it works: Each time you meet a treatment goal or milestone, you’ll get the opportunity to draw a slip of paper out of a fish bowl spelling out what your prize is.

This might be cash, candy, a gift card or certificate, or another prize with monetary value.

Is Contingency Management Effective In Treating Substance Use Disorder?

Research shows incentive-based treatment interventions like CM can be a beneficial and cost-effective treatment option for people with addiction.

According to the U.S. National Institute on Drug Abuse, its effectiveness has been demonstrated in both methadone programs and psychosocial counseling treatment programs. 

Contingency management can help to:

• increase treatment attendance
• reduce drug use behaviors
• promote abstinence (often demonstrated by a drug-free urine sample)
• promote other examples of positive behavior change

What Are The Limitations Of Contingency Management?

Compared to other evidence-based therapies for addiction, contingency management is not commonly offered by addiction treatment centers or outpatient treatment providers. 

Concerns About CM Interventions

Use of CM is controversial, due to concerns from critics that it could promote gambling – a claim that has been debunked by studies on CM – or that cash incentives could be used to buy drugs.

The U.S. National Institute on Drug Abuse (NIDA), however, in addition to many healthcare researchers, say it can effectively promote abstinence and treatment retention.

Limitations On Cash Incentives

Currently, guidance from the federal government on CM treatment places limits on the maximum monetary value of CM incentives.

Under existing guidance, incentives cannot exceed $75 in monetary value annually. Advocates for this treatment say that limit is insufficient and needs to be raised.

The Associated Press reports that, due to the demonstrated success of CM, the U.S. Department of Health and Human Services (HHS) is currently considering changes to those guidelines.

Does Addiction Treatment At Bedrock Offer Contingency Management?

Bedrock Recovery Center is a leading alcohol and drug abuse treatment center in Massachusetts, staffed with a highly trained team of addiction treatment providers. 

While our facility does not offer contingency management, our treatment programs do offer other evidence-based therapies that are shown to effectively treat addiction.

Therapies we offer include:

• cognitive behavioral therapy (CBT)
• dialectical behavioral therapy (DBT)
• motivational interviewing
• internal family systems
• mindfulness based cognitive therapy
• group therapy

You can learn more about our treatment programs for drug and alcohol dependence by exploring our website, including more information about our detox and residential inpatient programs. 

Begin Your Addiction Recovery Journey Today

Our treatment center is a leading choice for substance use disorder and co-occurring mental health disorder treatment. 

For more information about our treatment programs, call our helpline to speak with a treatment specialist today.