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Contingency Management: An Evidence-Based Approach to Addiction Recovery
Hannah is a writer with a focus on holistic wellness. Her work explores post-traumatic growth and the connection between physical and mental health. In addition to writing for Recovery.com she has written meditations for NatureSpace and is a licensed massage therapist.
Hannah is a writer with a focus on holistic wellness. Her work explores post-traumatic growth and the connection between physical and mental health. In addition to writing for Recovery.com she has written meditations for NatureSpace and is a licensed massage therapist.
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.16
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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Petry NM. Contingency management: what it is and why psychiatrists should want to use it. Psychiatrist. 2011 May;35(5):161-163. doi: 10.1192/pb.bp.110.031831. PMID: 22558006; PMCID: PMC3083448.
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Higgins ST, Petry NM. Contingency management. Incentives for sobriety. Alcohol Res Health. 1999;23(2):122-7. PMID: 10890806; PMCID: PMC6760431.
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Washington State Institute for Public Policy. https://www.wsipp.wa.gov/BenefitCost/Program/294. Accessed 19 Apr. 2023.
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Higgins ST, Petry NM. Contingency management. Incentives for sobriety. Alcohol Res Health. 1999;23(2):122-7. PMID: 10890806; PMCID: PMC6760431.
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Adam Creveling, MSW & Paul Brasler, LCSW. “Virginia Medicaid Contingency Management.” The Centers for Medicare and Medicaid Services: SUPPORT Act Section 1003 Grant Department of Medical Assistance Services. December 14 & 16, 2021. https://www.dmas.virginia.gov/media/4188/34-contingency-management.pdf
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Iguchi MY, Stitzer ML, Bigelow GE, Liebson IA. Contingency management in methadone maintenance: effects of reinforcing and aversive consequences on illicit polydrug use. Drug Alcohol Depend. 1988 Oct;22(1-2):1-7. doi: 10.1016/0376-8716(88)90030-0. PMID: 2906863.
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Schottenfeld RS, Chawarski MC, Pakes JR, Pantalon MV, Carroll KM, Kosten TR. Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. Am J Psychiatry. 2005 Feb;162(2):340-9. doi: 10.1176/appi.ajp.162.2.340. PMID: 15677600.
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Sayegh CS, Huey SJ, Zara EJ, Jhaveri K. Follow-up treatment effects of contingency management and motivational interviewing on substance use: A meta-analysis. Psychol Addict Behav. 2017 Jun;31(4):403-414. doi: 10.1037/adb0000277. Epub 2017 Apr 24. PMID: 28437121.
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Petry NM. Contingency management treatments: controversies and challenges. Addiction. 2010 Sep;105(9):1507-9. doi: 10.1111/j.1360-0443.2009.02879.x. PMID: 20707772; PMCID: PMC3049167.
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Petry NM. Contingency management: what it is and why psychiatrists should want to use it. Psychiatrist. 2011 May;35(5):161-163. doi: 10.1192/pb.bp.110.031831. PMID: 22558006; PMCID: PMC3083448.
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McPherson SM, Burduli E, Smith CL, Herron J, Oluwoye O, Hirchak K, Orr MF, McDonell MG, Roll JM. A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. Subst Abuse Rehabil. 2018 Aug 13;9:43-57. doi: 10.2147/SAR.S138439. PMID: 30147392; PMCID: PMC6095117.
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NIDA. 2022, August 31. Five Areas Where “More Research” Isn’t Needed to Curb the Overdose Crisis. Retrieved from http://nida.nih.gov/about-nida/noras-blog/2022/08/five-areas-where-more-research-isnt-needed-to-curb-overdose-crisis on 2023, April 19
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NIDA. 2022, August 31. Five Areas Where “More Research” Isn’t Needed to Curb the Overdose Crisis. Retrieved from http://nida.nih.gov/about-nida/noras-blog/2022/08/five-areas-where-more-research-isnt-needed-to-curb-overdose-crisis on 2023, April 19
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Fadus MC, Squeglia LM, Valadez EA, Tomko RL, Bryant BE, Gray KM. Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies. Curr Psychiatry Rep. 2019 Sep 14;21(10):96. doi: 10.1007/s11920-019-1086-0. PMID: 31522280; PMCID: PMC7241222.
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“SCREENING AND TREATMENT OF SUBSTANCE USE DISORDERS AMONG ADOLESCENTS.” Substance Abuse and Mental Health Services Administration’s (SAMHSA). https://store.samhsa.gov/sites/default/files/pep20-06-04-008.pdf
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Ingel, Sydney N., et al. “Juvenile Probation Officer Perceptions of Parental Involvement in Juvenile Probation and With Contingency Management.” Criminal Justice and Behavior, vol. 50, no. 1, Jan. 2023, pp. 40–55. DOI.org (Crossref), https://doi.org/10.1177/00938548221106468.
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Higgins ST, Petry NM. Contingency management. Incentives for sobriety. Alcohol Res Health. 1999;23(2):122-7. PMID: 10890806; PMCID: PMC6760431.
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Petry NM, Alessi SM, Olmstead TA, Rash CJ, Zajac K. Contingency management treatment for substance use disorders: How far has it come, and where does it need to go? Psychol Addict Behav. 2017 Dec;31(8):897-906. doi: 10.1037/adb0000287. Epub 2017 Jun 22. PMID: 28639812; PMCID: PMC5714694.
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