How to Use Contingency Management to Treat Addiction

The treatment of addiction is important because it restores a person to an active, social, and a drug-free lifestyle. We recommend taking such steps as soon as possible, especially if you have a loved one who is an addict. This is to ensure that treatment takes place before further damage to the brain. Research has demonstrated the effectiveness of using tangible rewards to enforce positive behaviors in addictions. Such approaches use contingency management principles.

The method appears to be efficacious in treating addictions. In fact, researchers using psychological counseling and methadone treatment programs have revealed that incentive-based interventions are highly effective in promoting abstinence from drugs and increasing treatment retention.

Contingency management capitalizes on rewards as a motivational incentive. This implies that it is a type of behavioral modification intervention that yields positive behaviors such as halting the abuse of drugs, including opioids. However, the main goal is facilitating drug use abstinence. So what makes contingency management effective in treating addictions? This article highlights what contingency management is, its benefits, and how to use it to treat addiction.

What Is Contingency Management?

Contingency management has been shown to be highly effective in a range of issues, such as impulsive behaviors, substance abuse, and defiance. Contingency management (CM) treatment is typically based on utilizing a simple behavioral principle–if a behavior is rewarded or reinforced, it is more likely to recur in the future. This principle is used every day.

For instance, parents use desserts and allowances to encourage children to make their beds or eat their meals. Employers use the same strategy by paying their employees and adding some bonuses to reward good job performance. When used in substance abuse treatment, CM enforces drug abstinence along with other positive behaviors consistent with a drug-free lifestyle, via the use of behavioral principles.

History of CM and Theoretical Basis

Contingency Management and Substance Abuse Treatment

Benefits of Contingency Management

A series of studies have demonstrated that CM is efficacious in reducing substance abuse and in treating addiction. One such study entailed randomly assigning cocaine-dependent outpatients to 12-step-oriented treatment or contingency management treatment in which they received individual behavioral therapy along with vouchers each time the urine specimens tested negative for drugs. The patients who had been assigned to the contingency management group continued treatment longer and diminished cocaine use compared to patients in the 12-step group.

Other studies have affirmed that the contingency management approach is so effective that patients discontinue the intake of drugs. Contingency management works for patients who have been addicted to cocaine and even other opioids.

Contingency management effectively reinforces abstinence, and the variation of the approach is effective in realizing behavioral modifications of substance abusers. This means that CM will likely produce viable results among drug abusers. Even though it is expensive (it costs an average of $200 per client), it improves outcomes drastically. If you intend to ensure that your loved one's addiction is treated, money wouldn't matter.

While people may assert that CM encourages gambling, research has established no connection to gambling addiction. Contingency management is primarily beneficial since it enforces drug abstinence along with other positive behaviors consistent with a drug-free lifestyle, which is reinforced using the same behavioral principles. The added benefits or incentives will help promote a social, active, as well as a drug-free lifestyle.

How to Use Contingency Management to Treat Addiction

A person's hands is going to get a lot of medical drugs

Image by Emilian Danaila from Pixabay

There are two main variations of contingency management–prize incentives CM and voucher-based reinforcement (VBR). In VBR, the person who is addicted receives one voucher for each urine sample that he or she provides that doesn't contain a drug of abuse. In that case, the value of the voucher is low initially.

However, over time, it is increased to provide a greater desire to provide the sample and imposes a sense of accomplishment when the addict tests clean of any drug. The vouchers are provided for example on a weekly basis. Once the person accumulates enough of them, he or she can exchange them for desirable activities, items, or food. The added benefits or incentives will help promote a social, active, and a drug-free lifestyle.

Price incentives CM, on the other hand, makes it possible for the patient or client to earn select prizes from a bowl by providing urine samples that are drug-free, taking prescribed medications, and attending treatment among other desired positive behaviors. The prizes are written on a piece of paper and assigned a specific value, for example, $100. The more the addict or patient conforms to desired behaviors, the better the chance for a larger prize.

Principles to Guide Treatment

There are seven principles that need to be followed. These are:

  1. 1
    Identifying a target behavior, which can either be a negative or a positive to be reduced or increased, respectively
  2. 2
    Contingency management is perfect for new clients or patients who have had poor rates of success in treating addiction in the past
  3. 3
    The reinforcer is the central aspect of a CM program and should include a reward that is valued by the client or addict, which means it has to be realistic and desirable
  4. 4
    There should be enough resources to maintain the CM's reward system
  5. 5
    The CM program should reinforce the desired behavior at a specified rate based on the specific needs of the client or addict
  6. 6
    The timing of the incentive is as important as the frequency and should be given immediately once the desired behavior is complete
  7. 7
    The goal of CM is achieving the desire of sobriety when the rewards are discontinued, which means that some addicts or clients may take longer than others.


Contingency management uses motivational incentives and is a type of behavioral therapy rooted on the basis of operant conditioning. It provides rewards to induce desired behaviors such as clean drug tests. Sometimes, disciplinary measures can be taken, such as withholding of privileges when the client engages in undesirable behavior. CM has been shown to be highly effective in a range of issues, such as impulsive behaviors, substance abuse, and defiance.

Since client needs vary, it can be modified slightly. It can also be used as a stand-alone treatment or in combination with other treatment methods such as medication management, cognitive-behavioral therapy (CBT) motivational interviewing, and medication maintenance programs for individuals in recovery. We hope this article has adequately addressed what contingency management is, its benefits, and how to use it to treat addiction.

Featured Image: Image by Ronny K from Pixabay

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