Contingency management (CM) treatments evolved from basic behavioral research demonstrating that reinforcing behavior increases the probability it will occur in the future. CM is a structured behavioral therapy that involves: (1) frequently monitoring an objectively verifiable target behavior, (2) reinforcing the behavior each time it occurs using tangible reinforcers, and (3) withholding reinforcement when the target behavior is not met. Often, the target behavior is drug abstinence, but other behaviors such as attendance at treatment, medication adherence, and engagement in treatment-related activities, can also be reinforced. Patients earn reinforcement contingent upon submission of drug negative urine samples or treatment attendance. The two most common CM delivery systems are Prize-based (fishbowl) CM and Voucher CM. In Prize-based CM, patients earn draws from a fishbowl with the chance to win prizes ranging from $1 to $100 in value. In Voucher CM, patients earn set dollar amounts in vouchers; earned vouchers are exchangeable for goods and services. In both Prize- and Voucher-CM, reinforcers typically increase with sustained demonstration of the target behavior.
Usually, CM treatments are in effect for 8-24 weeks, and CM is often provided as an adjunct to other treatment. It can be integrated with virtually any form of therapy, including eclectic/standard group treatment, 12-step therapy, cognitive-behavioral therapy, community reinforcement approach therapy, motivational enhancement therapy, and others.
If abstinence is reinforced, the best outcomes of CM are generally achieved if abstinence from a single drug or single drug class (e.g., stimulants) is reinforced (as opposed to requiring abstinence from multiple substances concurrently to receive reinforcement), if urine testing monitoring is conducted at least twice weekly, if onsite (as opposed to offsite) testing procedures are used to allow for immediate results and reinforcement, and if reinforcement magnitude is consistent with evidence-based protocols.
Meta-analyses and Systematic Reviews
- Contingency management in outpatient methadone treatment: A meta-analysis (Griffith et al., 2000)
- A meta-analysis of voucher-based reinforcement therapy for substance use disorders (Lussier et al., 2006)
- Contingency management for treatment of substance use disorders: A meta-analysis (Prendergast et al., 2006)
- A meta-analytic review of psychosocial interventions for substance use disorders (Dutra et al., 2008)
- Prize-based contingency management for the treatment of substance abusers: A meta-analysis (Benishek et al., 2014)
- Contingency management for patients receiving medication for opioid use disorder: A systematic review and meta-analysis (Bolívar et al., 2021)
- Long-term efficacy of contingency management treatment based on objective indicators of abstinence from illicit substance use up to 1 year following treatment: A meta-analysis (Ginley et al., 2021)
- Contingency management for treatment attendance: A meta-analysis (Pfund et al., 2022)
Clinical Trials
- A behavioral approach to achieving initial cocaine abstinence (Higgins et al., 1991)
- Achieving cocaine abstinence with a behavioral approach (Higgins et al., 1993)
- Incentives improve outcome in outpatient behavioral treatment for cocaine dependence (Higgins et al., 1994)
- Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy (Silverman et al., 1996)
- Prize reinforcement contingency management for treatment of cocaine abusers: How low can we go, and with whom? (Petry et al., 2004)
- Vouchers versus prizes: Contingency management treatment of substance abusers in community settings (Petry et al., 2005)
- Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: A National Drug Abuse Treatment Clinical Trials Network Study (Petry et al., 2005)
- Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: A National Drug Abuse Treatment Clinical Trials Network study (Peirce et al., 2006)
- Clinical trial of abstinence-based vouchers and cognitive-behavioral therapy for cannabis dependence (Budney et al., 2006)
- Contingency management for the treatment of methamphetamine use disorders (Roll et al., 2006)
Video Repository
- Promoting Awareness of Motivational Incentives
- Promoting Awareness of Motivational Incentives webinar
Measures, Handouts and Worksheets
- Rating contingency management sessions that reinforce abstinence using the Contingency Management Competence Scale (Ledgerwood & Petry, 2010)
- The Contingency Management Competence Scale for Reinforcing Attendance (Petry & Ledgerwood, 2010)
- Adapting the helpful responses questionnaire to assess communication skills involved in delivering contingency management: Preliminary psychometrics (Hartzler, 2015)
Training Materials and Workshops
Related Diagnosis
Substance and Alcohol Use Disorders
EST Status
N/A
2015 EST Status
Strong
2015 EST Report Link
CM-Tolin-Criteria-Evaluation-Report-.pdf
1998 EST Status
N/A