Contingency Management in Addiction Treatment

Addiction treatment shouldn’t come in a one size fits all package.

At Rehab 4 Alcoholism, we have a strong belief that everyone is different and every addiction sufferers comes with their own set of experiences.

Therefore, need to be treated as such.

This means that we offer a range of treatment programs at our partner rehab facilities to ensure there are things in place to meet your individual needs and treatment goals, regardless of your situation.

One of the ways we do this is by ensuring our selection of therapies is as varied as possible.

One therapy that is widely offered has a longer history in psychotherapy and therapeutic treatment than others.

This page will tell you all you need to know about the use of contingency management in addiction treatment, answering some frequently asked questions, including:

• What is contingency management?
• How does it work?
• What is it used for?
• Why is it helpful in addiction treatment?
• What different kinds of contingency management are there?
• What other forms of support complement contingency management?

What is Contingency Management?

Contingency management is a kind of support that hinges on rewards and positive reinforcement.

A lot of the time, when we think about therapy we might imagine that by talking about how we feel and revealing difficult thoughts and feelings we don’t usually share, as we believe that we may be judged, punished, or shunned.

In contingency management, the attention is taken away from this idea of punishment, and instead, focuses on what can be celebrated and rewarded.

This is a way of building positive associations with positive behaviours, and therefore allowing us to build better habits and also, importantly, to feel good about ourselves.

How Does Contingency Management Work?

Contingency management is a form of behavioural therapy.

It works by putting the emphasis on rewarding people for making positive changes and displaying healthy behaviours.

This type of therapy is used in addiction treatment programs and is frequently used alongside other forms of therapeutic intervention as it can positively affect an individual’s retention in treatment.

This means that, like forms of motivational therapy,  this form of therapy can actually help people to stay in treatment in general.

What is Behavioural Therapy?

Behavioural therapy is linked to ideas formed by behaviourist psychologists.

Behaviourism is an approach to psychology that specifically focuses on human behaviour and how it can be shaped, developed, or changed.

Historically, the behavioural approach is associated with psychologists and practitioners such as B.F. Skinner.

B.F. Skinner is known as the ‘Father of Behaviourism’.

Skinner’s research was to do with how behaviours can be learnt, or in behaviourist terms, conditioned.

These conditioning principles can be applied in many different circumstances.

Skinner’s approach, however, focused on operant conditioning principles.

This means that he focused on how we learn and change our behaviours as a reaction to punishment.

Contingency management does not apply operant conditioning.

What it does do, though, is take the ideas from behaviourism that certain responses can cause us to associate our behaviours with good or bad feelings.

In fact, part of the treatment is withholding judgement and ensuring individuals do not feel shameful or as though they have failed by, for example, beginning to drink again.

By privileging the positives, contingency management hopes to teach people to begin to see the good things that they are achieving, rather than focusing on the areas that they might be struggling in.

This can help people increase their confidence, self-esteem, and their willingness to continue with treatment.

Contingency management works through the practice of helping people associate healthy, meaningful recovery efforts with rewards.

Because recovery can be so tricky, this can help people feel more motivated to continue their progress, and therefore, be more likely to achieve sobriety.

Different Kinds of Contingency Management

The foundations of this kind of therapy can be applied in several different ways in a range of different forms of intervention.

Typically, contingency management functions through the process of achievement equalling a reward of some kind.

This form of reward system can take different forms depending on the individual and the way in which an alcohol and drug treatment setting may run.

A common incentive, however, is the use of voucher-based reinforcement therapy.

In this context, contingent vouchers can be used as a kind of financial reward for recovery successes.

1. Finding Motivation

This works on the basis that engaging with substance abuse treatment is tricky – it is hard to take the path to recovery, and many people find that working towards sobriety is an active decision that you must take each day.

Contingency management then, in its effort to reward positive behaviours and the ‘little wins’ of the treatment process is a kind of prize-based programme.

This can help to keep individuals in treatment, offer you extra motivation, and most importantly, make what can often be a difficult treatment programme, a little more fun.

The successes that will be rewarded will be aligned with your desired treatment outcome.

For example, if one goal in your treatment plan is to attend and engage in group therapies, you may find that receiving desirable rewards for doing this may help you find the motivation to try and do so.

The successes that will be celebrated are known as ‘target behaviours.’

By establishing target behaviours in advance, you can have a tangible idea of the steps you can take to help you move forward.

When you achieve one of your target behaviours, you will be given a reward.

These could come in many different forms, including:

• Cash incentives
• Prize incentives
• Prize draws

These will usually not be ‘actual’ cash but will be vouchers that correspond to certain activities or items that may be desirable to you.

2. Negative Drugs Test

Around ten years ago, one of the most common uses is the giving of a reward or motivational incentive to an individual following a negative drug screen (they have a drug test, and it shows up as a negative sample).

Drug testing can be a key part of addiction treatment.

It can be there to help you ensure that you are staying safe and are refraining from using substances during your contact with drug services.

This is not used as much today, as there is a fear from some individuals that this could promote what feels like an uncomfortable context of surveillance.

Instead, there are now different ways to monitor and incentivise drug abstinence during contingency management intervention.

3. Treatment Attendance

One of the ways that contingency management can be used is through rewarding positive behaviours in clinical settings.

For example, if you find it difficult to engage with different elements of the treatment process, it may be helpful to set attending 1-1 therapy or contributing to group therapy as a behaviour associated with personal success.

4. Engaging with Medical Care

One of the trickiest things in addiction treatment can be managing medication.

This can be for several reasons.

Maybe you find it difficult to take your medication because you forget, or because your mood is low, and you struggle to find the motivation to do so.

Equally, you may not want to take your medication for personal reasons.

However, medical professionals prescribe medications for a reason. They are there to keep us healthy and safe.

Whilst if you have an issue with a particular medication you are taking, you should discuss these concerns with a medical professional. The vast majority of the time, taking medication is the best way to keep healthy.

For this reason, contingency management can be used in helping people associate taking their medication with success.

In certain situations, such as in methadone maintenance treatment (which is commonly used in treatment for heroin dependence) taking medication is crucial to ensure you stay on the right track.

For this reason, receiving positive reinforcement through celebrating the win of taking your medication can have a genuine positive impact on your health and recovery process.

It means taking your medication can become a little easier, before becoming second nature.

Contingency Management in Addiction Treatment

Unlikely many other forms of therapy offered by addiction treatment providers, contingency management is almost solely used to support individuals with substance use disorders.

Researchers have stated that ‘contingency management is a highly effective treatment for substance use and related disorders.’

The aim of contingency management is to take the focus away from what has gone wrong.

When we are trying to move forward from something, it doesn’t help to always be thinking about what might have gone wrong, or where things have been difficult.

In order to help you to feel motivated and in control of your own feelings and behaviours, contingency management therapy aims to highlight the ways in which you are already taking the relevant steps towards a sober life.

We all deserve to feel good for our positive behaviours and to be allowed to make mistakes, both in alcohol and drug addiction treatment and in our daily lives.

The core principle of contingency management is to allow you to remember that every small action you take towards recovery is a giant step towards a life of continuous abstinence.

What Kinds of Addiction Therapy Complement Contingency Management?

It is very uncommon for contingent reinforcement to be used on its own.

In successful treatment for substance misuse, contingency management treatment needs to be used in tandem with other forms of treatment.

Whilst it can have positive effects, behavioural therapy should be used with other treatment options that can help us explore other, often deeper, things that may have led towards risky drinking and the use of illicit drugs.

Contingency management can be great in helping us get into a positive mindset that allows us to feel more ready to approach and discuss these topics with an open, determined mind.

Some of the other types of therapeutic support offered at drug and alcohol rehab that can complement contingency management programmes include:

• Alcohol Addiction Counselling
• Cognitive Behavioural Therapy
• Dialectical Behavioural Therapy
• Equine Therapy
• Family Therapy
• Self-Help Groups
• Individual Therapy

The Effectiveness of Contingency Management in Addiction Treatment

Generally, the use of contingency management incentives has very beneficial effects in the treatment of addiction to drugs and/ or alcohol.

One study looked at the outcomes of individuals who had contingency management treatment over a period of 12 weeks compared to individuals who did not.

They found that 49% of people who had contingency management therapy as part of their recovery plan stayed in treatment for the duration of their recovery plan.

In comparison, only 35% of individuals without contingency management treatment finished their support package.

It improves the likelihood that people will stay in treatment for the duration of their programme, helps to improve feelings of motivation, self-worth, and self-esteem, and suggests the possibility of longer-term sobriety.

Contact Us Today

Explaining what it feels like to battle with an addiction can feel impossible.

We can feel lonely and trapped, and not know where or who to turn to.

How do we begin to talk about our feelings, where should we go for support, and what are we supposed to say to them?

At Rehab 4 Alcoholism we know that addiction is not a choice.

We also know that every individual is different and that it is ok for recovery processes to take as long as they may need.

We also know that everyone struggling with controlling their drinking deserves a helping hand to get back on the right track to sober living.

If you are ready to access support for addiction, or believe that a loved one would benefit from beginning formal support, we are more than happy to speak with you and learn more about how we can help you with your current situation.

We are a confidential service, and all our contact with you is designed to help offer you relief, peace of mind and genuine opportunities for long-term recovery.

You can contact our team to seek advice and to learn more about the kinds of services we offer, so call us today on 0800 111 4108 and start your journey towards sobriety.