Learn Contingency Management: An Evi...

Contingency Management: An Evidence-Based Approach to Addiction Recovery

Contingency Management: An Evidence-Based Approach to Addiction Recovery
By
Hannah Friedman
Published April 19th, 2023
Clinically Reviewed by
Rajnandini Rathod

Table of Contents

Recovering from addiction is hard work. It can take conscious effort to resist cravings. However, some treatment centers use contingency management to reward you for continuing abstinence from drugs or alcohol. And those rewards help you focus on healing, even during stressful times.

What Is Contingency Management (CM)?

Contingency management (CM) is a behavioral treatment option1 for people recovering from substance use disorder. This therapy revolves around positive reinforcement. In other words, patients get rewards for certain activities, encouraging them to keep it up. When you’re in addiction recovery, you might get rewards for sobriety or just for staying in treatment.

Contingency management theory is based on the idea that changing your environment can change your behavior. In an environment that rewards sobriety, you’re more likely to commit to addiction treatment. Treatment rewards include tangible prizes, like vouchers or even cash.

For example, if you submit a drug-negative urine sample or attend your scheduled therapy session, then your therapist might give you a voucher. And the longer you sustain this positive behavior, the larger the rewards get. So after one day of drug-free urine samples, you could receive $1. After a year of proven, sustained abstinence, you could receive up to $100. But if you relapse, your rewards will reset back to the beginning.

How Does Contingency Management Work?

The first step in many contingency management therapy programs is writing a contract between the provider and the patient.2 In this contract, you’ll agree to:

  • Perform a specific type of desired behavior (like abstinence from drugs and alcohol or attending other therapy sessions)
  • Stay in treatment for a certain amount of time
  • Submit drug tests on a set schedule

In turn, your provider will commit to giving you specific, predictable rewards based on your behavior. If you keep the commitments in this contract, you’ll know exactly which rewards to expect.

Most people are in contingency management programs for a year3 or less. Depending on your program, you may have to submit urine tests daily4 or 2-3 times a week. You may test in your therapist’s office before attending a counseling session, or you might have to submit tests through a third-party testing center.

The rewards you earn also depend on your program. One popular reward option is a voucher that you exchange for goods, which increase in value the longer you stay sober. Other programs give you money, gift cards, or the opportunity to win prizes like movie passes. Some states limit the total amount5 that patients can earn. For example, in Virginia, patients can only earn up to $75 annually.

CM can be helpful in every phase of recovery. For example, many patients use this approach during detox from substances like opioids, in combination with other treatments. It may also be a good aftercare option for people leaving residential rehab.

Contingency Management as Part of Your Larger Treatment Plan

Contingency management is a supplementary therapy, so it likely won’t be the only addiction treatment you use. Most providers combine this treatment with medication, talk therapy, or other types of care.

Contingency Management and Pharmacotherapy

If your treatment plan includes medication-assisted treatment for substance use, like methadone, your CM program may reward you for taking your medication. You might also get rewards for safely taking methadone doses at home,6 or reaching other recovery milestones.

CM is very effective for patients using methadone maintenance therapy7 and other addiction medications. Participating in contingency management therapy actually improves the outcomes of these treatments.

Because drug tests are a regular part of most contingency management programs, make sure your entire team knows about any medications you’re taking. Most providers will include that information in your initial CM contract. This helps patients stay accountable throughout treatment.

Contingency Management With Other Psychosocial Therapies

Combining contingency management with other types of therapy can maximize the benefits of treatment. Rehabs like Renaissance Recovery in California integrate contingency management into their programs for this very reason. Patients attend both behavioral and psychotherapy sessions to learn new relapse prevention techniques. For example, you might combine CM with cognitive behavioral therapy (CBT).

Some studies suggest that contingency management helps most in the short term,8 while other methods like motivational interviewing can help you commit to long-term sobriety. However, other studies show that patients who have undergone contingency management therapy in the past continue to abstain from drugs9 or alcohol even after they stop getting rewards.

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Can Contingency Management Help With Addiction?

Contingency management is a very effective treatment10 option for addiction to opioids, stimulants, alcohol, benzodiazepines, marijuana, and tobacco. Researchers from Washington State University describe contingency management as “one of the most effective behavioral interventions11 for initiating and maintaining abstinence from alcohol and drugs.” Dr. Nora Volkow, Director of the U.S. National Institute on Drug Abuse takes it even further, saying “we don’t need more science to show the effectiveness of contingency management.12 We need more treatment centers to implement it.”

CM works because of the way addiction affects your brain’s reward systems.13 As addiction develops, your brain starts to only recognize pleasure (the reward) when you drink or use drugs. Even things that used to bring you pleasure—like family time or career success—start to feel less rewarding. Contingency management replaces the reward of getting high with that of getting a prize. It motivates patients to sustain abstinence because of this potential reward.

Contingency Management for Teens

Data supports contingency management as a treatment for teens14 with addiction. Experts say that family involvement is vital to this process. Some rehabs can facilitate that through group therapy sessions. For example, your program may offer CM as part of family therapy.15

Contingency management can help teens with more than addiction recovery. It’s also effective for young people on probation15 and students using CM to stay in school.

Other Benefits of Contingency Management

CM can also help adults with a variety of goals. For example, some treatment programs strategically use their vouchers to promote drug-free activities.17 So you may receive a voucher for a free class at the local yoga studio, which encourages you to learn a new skill and have fun without using drugs. Finding new ways to enjoy yourself is an essential part of recovery.

Contingency management also helps patients build confidence.18 Tangible signs of your own success can boost your self-worth. It’s also easy to track your progress as each reward increases in value. Plus, earning small rewards consistently can add moments of happiness as you begin a new chapter of your life.

Contingency Management Rewards You for the Hard Work of Recovery

For many people, sustained recovery doesn’t come from a single type of therapy. Because addiction impacts every aspect of your life, treatment has to do the same. Talk therapy can teach you healthier coping skills, and complementary treatments can help you explore your emotions. While you’re doing that, contingency management both validates and rewards your progress.

Search rehabs to find a program that meets your needs and reach out to centers directly.

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