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Contingency Management 

Positive Reinforcement

Contingency management (CM) is a type of therapy focusing on external behavioral influences. Through a system of motivational incentives, contingency management offers recovering addicts with rewards for positive behavior patterns. For example, when a client tests clean following a random drug or alcohol test, the reward might be increased privileges. Should negative behaviors begin to surface, there are measures taken to step back certain extra privileges. Much like the reward system for a young child, this type of behavior management gives inpatient drug rehab and sober living staff control over the environment and motivates positive choices.

This type of behavioral reinforcement is used for drug addiction treatment, impulsivity and disregard for authority. Contingency management can be applied in conjunction with other treatments or can be a stand-alone addiction treatment tool. Many find that when combined with other drug and alcohol treatments the result is positive all around. Some of the other types of treatments that CM is combined with are the following:

  • Motivational Enhancement
  • Medication Management
  • Moderation Management
  • Cognitive Behavioral Therapy
  • Biofeedback Therapy

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Contingency Management for Addiction

 

While the specific reward systems may differ within addiction treatment programs, there are a few that are more common than others. These forms of positive reinforcement give patients a gauge of their progress and a sense of responsibility they may not have previously engaged in their day to day lives.

Voucher Incentives

Using vouchers for each clean drug test can be an easy way to encourage patients to carefully consider their choices. The opportunity to leave treatment for even a few hours in order to participate in group events such as movies, dining out or other low-risk activities gives each client a chance to feel normal. The value assigned to each voucher can increase as the patient progresses and positive changes are seen.

Prize Incentives

Very similar to voucher incentives, these give patients the chance to win prizes. Sometimes managed on point value, the drive to attain a new level of respect for self and in front of peers can be motivation to attend meetings on time, complete treatment program steps and remain medication compliant.

Seven Principals of Contingency Management

 

1. Target Behavior. Before any CM plan can be successful, the negative behavior patterns need to be identified. Some common negative behaviors can be dealing or using drugs, stealing to support their addiction or compulsive denial. Compiling a list of positive replacement behaviors can give clients the ability to see alternatives and seek to make behavioral changes.

2. Choice of Target Population. Not every client in drug and alcohol treatment programs will desire to take part in CM as they already have a strong desire to progress without outside incentives. Contingency Management was developed with the relapsing client in mind.

3. Choice of Reinforcer. Each individual client has different positive reinforcement tools that they respond to more than others, therefore it is important to help choose the appropriate ones. Some rewards have little or no meaning to clients and it is the therapist’s job to work closely with clients to develop realistic reinforcers.

4. Incentive Magnitude. Depending on a center’s specific financial resources the rewards can be substantially scaled to include access to upgraded housing, car usage or gaming electronics. The key is to find a balance between excess and reward. Individuals with lengthy addiction histories may need these higher level incentives.

5. Frequency of Incentive Distribution. Ideally, the rate of rewards should be individualized from client to client although many CM programs use standardized times intervals to give patients a sense of structure and compliance initiative.

6. Timing of Incentive. The time between the positive behaviors and reward is often immediate as the association between incentives and desired behaviors are important to the success of the program.

7. Duration of Intervention. The goal of any Contingency Management program for substance addiction is sobriety. Ultimately this should be the goal first, and the reward system should remain in place until the individual feels they can maintain sober living without them.

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