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Contingency Management in Addiction Treatment

Evidence-based behavioral therapies like contingency management are often used as a part of a comprehensive addiction treatment plan.1 Finding a treatment center that offers contingency management may be helpful for your, or a loved one’s, recovery. This page will help you learn more about contingency management, including how it works as a part of a comprehensive addiction treatment plan, and how to find a facility that offers contingency management near you.

What Is Contingency Management?

Contingency management for addiction is a type of behavioral therapy that provides external reinforcers to evoke desired behavioral changes.2 Contingency management has extensive research to support its efficacy in the context of substance misuse and substance use disorder (SUD) treatment.3 Specifically, contingency management has been shown to increase a person’s motivation to make positive behavioral changes and can help people reduce their substance use.2

Contingency management is based on principles of basic behavioral analysis and operant conditioning, which involves the idea that behaviors that are positively reinforced shortly after the behavior occurs will be more likely to occur again.3 Operant conditioning refers to the way that people learn new behaviors through stimuli like receiving rewards.4

How Does Contingency Management Work?

Contingency management for addiction treatment works by helping people identify target behaviors and providing tangible reinforcers when target behaviors occur.2 Similarly, the reinforcer is withheld when target behaviors do not occur.5 In other words, behaviors associated with abstinence (e.g., negative drug tests) are positively reinforced, or rewarded, while behaviors that are associated with substance use (e.g., positive drug tests) are negatively reinforced, such as withholding the reward.6

Contingency management involves 3 key concepts, including:5

  • Monitoring of a target behavior that can be objectively verified.
  • Reinforcing the target behavior using tangible rewards when it occurs.
  • Withholding the reward when the target behavior does not occur.

Target behaviors in the context of addiction are often negative drug tests or urine screens, but may also include adhering to a treatment plan, attending treatment, and taking medications as scheduled.4, 5

Reinforcers are tangible rewards. These can be monetary, such as cash or gift cards, or non-monetary, such as vouchers to exchange for goods.4 They can also be specific to the individual and include activities, foods, objects they enjoy, anniversaries, or specific goal dates.2 For example, someone who achieves a milestone, such as attending a specific number of counseling sessions, may receive a reward of planning a special dinner.2

There are 2 main types of contingency management, including:1

  • Voucher-based contingency management. People who achieve the target behavior earn vouchers that can be exchanged for tangible goods or services, such as movie tickets. The value of the vouchers typically increases as the number of consecutive target behaviors increases.
  • Prize incentives contingency management. This is similar to voucher-based contingency management, but people have the opportunity to win cash prizes instead of vouchers.

Contingency management can take place in various settings, including inpatient addiction treatment, where you live onsite at a treatment facility, or outpatient addiction treatment, where you live at home but travel to a treatment facility regularly.7 It can combined with other therapies used in rehab, including behavioral therapies, counseling, and pharmacotherapy.4

Goals of Contingency Management

The goal of contingency management in drug and alcohol rehab is to help people decrease or stop substance use and increase behaviors consistent with a substance-free lifestyle.6 Behaviors consistent with a substance-free lifestyle can include:1, 4, 5

  • Negative drug tests.
  • Adhering to a treatment plan.
  • Attending counseling sessions.
  • Completing weekly goal-related activities.
  • Taking medications as scheduled.

Does Contingency Management Help in Addiction Treatment?

Research shows that contingency management is effective for treating substance use disorder (SUD) because it is based on attainable, specific short- and long-term goals and positive behavioral change.3, 8 Contingency management can be especially effective when used as a part of a comprehensive addiction treatment plan that includes other behavioral therapies like cognitive-behavioral therapy (CBT), group and individual counseling, and medication.4, 8

Benefits of Contingency Management for Drug and Alcohol Addiction Recovery

Does contingency management help in rehab? Research shows contingency management can:2, 4

  • Reduce substance use, including alcohol, cocaine, marijuana, and opioid use, as well as polysubstance use (the use of 2 or more substances).
  • Increase the duration of abstinence.
  • Increase adherence to medications.
  • Increase overall treatment adherence.

Studies have shown that when combined with counseling and FDA-approved pharmacotherapy, contingency management can be especially useful for people who struggle with polysubstance use, including concurrent alcohol, cocaine, and opioid dependence and/or use.4

When comparing contingency management with other behavioral therapies, contingency management interventions have by far the greatest amount of empirical support for their efficacy among people with stimulant use disorders. Studies have shown it is effective in reducing cocaine and meth use, as well as other positive outcomes, including longer retention in treatment, greater number of therapy sessions attended, higher utilization of medical and other services, reduced high-risk sexual behavior, increased positive affect, and decreased negative affect.8

Contingency management can also be beneficial for people with substance use disorder (SUD) and co-occurring disorders, such as anxiety or depression, as well as more severe disorders like schizophrenia.9 For these people, when used in combination with other treatments, contingency management may help reduce substance use and the negative consequences associated with substance use.9 Several studies have also demonstrated the effectiveness of contingency management for reducing cocaine and marijuana use in people with psychotic disorders.3

Does Insurance Cover Contingency Management in Rehab?

The cost of rehab can vary depending on different factors, such as the type of treatment you receive, the setting, and whether you have insurance. Coverage can vary, but if you have insurance, your plan should cover at least some of the cost of rehab, which may include contingency management. The Affordable Care Act (ACA) lists addiction and mental health treatment as essential benefits, which means that insurance plans are required to provide some level of coverage.10

As health insurance coverage for rehab can vary, it’s advisable to check your specific benefits with your insurance carrier. You can also learn more about what’s covered by calling American Addiction Centers at . If you don’t have insurance, you can search for free or low-cost rehabs, or check with local and nonprofit community organizations.

Find Contingency Management Addiction Treatment Near You

If you or a loved one are interested in taking the next step and finding a rehab that offers contingency management, you have options. You can start by asking your doctor for referrals or calling treatment facilities to inquire about their programming.

American Addiction Centers is a leading provider of nationwide rehabs that offer contingency management and other evidence-based treatments. You can learn more about our therapies and rehabs by calling to speak to an admissions navigator about treatment options.

Other Proven Addiction Therapy Methods

In addition to contingency management, other evidence-based therapies have been proven effective for treating substance use disorder (SUD). These include:1, 9, 11

  • Cognitive behavioral therapy for addiction treatment (CBT). CBT helps people identify and modify maladaptive or unhealthy behaviors and thoughts associated with substance misuse.
  • Motivational interviewing for addiction treatment (MI). This is a short-term form of therapy used to help people develop and strengthen their internal motivation to change substance use and other associated behaviors.
  • Dialectical behavioral therapy for addiction treatment (DBT). DBT helps people with severe problems related to emotional regulation, including those with co-occurring borderline personality disorder (BPD) or suicidality.
  • Family therapy for addiction treatment. This can help people work through and resolve family issues related to substance misuse and improve overall family functioning.
  • Group therapy for addiction treatment. Groups are led by a trained therapist and involve other people in treatment; it can be used to provide different behavioral interventions and provide positive reinforcement.
  • 12-step facilitation therapy. This is a brief therapy that is designed to help people become active in 12-step self-help groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
  • Matrix Model for addiction treatment. This is a comprehensive therapy primarily used to treat stimulant addiction; it involves educational components, direction and support from a therapist trained in the Matrix Model, and familiarization with self-help programs.

In addition to the above-mentioned therapies, rehabs may also offer complementary or holistic therapies. Some research has shown that different complementary and holistic therapies can be useful for SUD recovery, such as:12, 13, 14, 15

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