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August 1, 2020

Why Contingency Management In Addiction Should Be Used More

Contingency Management (CM) is a highly effective method for patients in addiction recovery. Yet, this method is seemingly overshadowed by the more popular ones, leaving many not benefitting from CM techniques. Understand why CM should be used more in substance abuse treatment and how an increased awareness can be developed in the addiction community.

While it is true that there is no one-size-fits-all approach to battling substance abuse, there are methods that are proven to be more effective than others. According to the National Institute on Drug Abuse, Contingency Management (CM) is one of those effective approaches. An article from their website states that CM is ‘highly effective’ in studies involving methadone programs and psychosocial addiction treatments.

What is Contingency Management?

To understand why CM methods effective, it is essential to also know the core principles of this type of approach. The idea of this method is similar to Applied Behavioral Analysis (ABA) treatments, which provide positive reinforcements to encourage desired behavior. 

 

The word “contingency” comes from the thought that relapse is likely to happen without boundaries and reinforcements set in place. The method presented to control the likelihood of addiction relapse by giving rewards to patients in exchange for following through their sobriety goals.

What are the types of CM methods?

Within the context of a rehab facility, there are two kinds of CM methods:

 

 

  • Voucher-Based: In some drug and alcohol treatment centers, individuals can receive vouchers for every drug-free urine sample they present. These vouchers can be in the form of movie tickets, dinners, gift cards, and other incentives. The prizes increase in value when individuals present more consecutive drug-free urine samples. According to studies, the voucher-based program is effective for patients undergoing methadone detoxification for opioid and cocaine addiction.
  • Prize-Based: Aside from incentives, another method that could work is through the use of monetary prizes. Participants have the chance of winning cash prizes if they present negative drug tests. They can also have entry to these cash raffles if they join the sub-programs under their drug or alcohol addiction rehab, such as counseling, therapies, or support groups. 

 

Why is the CM Method Underused?

There are several reasons why Contingency Management interventions are not widely used. These all span from the perspective of the practitioners and rehab facilities, as well as anecdotal reports from patients themselves.

The worry of temporary results

Many addiction specialists fear that using CM may be ineffective in promoting lasting recovery. This is due to the thought that once incentives and prizes are gone, the motivation for recovery won’t last as well. Thus, many conclude that CM only presents temporary results in sobriety.

Encouraging gambling behavior

Other practitioners also worry that CM encourages other addictive behaviors such as gambling. When patients receive prizes in their rehab for alcohol or drugs, they may pool these monetary resources to use in casinos or gambling establishments. However, studies indicate that CM does not promote gambling behavior.

Lack of desire from patients

These prizes may be lucrative for patients in middle to low-income households. However, when high-income individuals are presented with these methods, they may not be as motivated to complete the tasks needed to be addiction-free.

 

Despite these reasons, Contingency Management interventions still stand strong in their effectiveness. Many researchers point out that CM techniques are highly effective in attaining sobriety goals, following through treatment plans, and even improving the moral of the rehab facility staff.

Why should CM methods be more widely used?

Many drug and alcohol abuse treatment centers may be struggling with their success rates in addiction recovery. CM could just be the answer to increase the success rates of patients in recovery, as proven in studies. There are many reasons why rehab facilities should implement this method:

 

Gradual transitioning from instant to delayed gratification

Some addiction treatment methods such as 12-Step or psychotherapies involve the understanding that some gratifications (wellness, better relationships, career advancement) are delayed. This is challenging for someone who has a substance abuse problem because they are wired to get pleasurable feelings right away. 

 

Thus, CM provides a middle ground for them to work on understanding that gratifications can be delayed in the meantime in exchange for a short-term prize in the form of incentives or cash. 

Promoting camaraderie within rehab facilities

The rehab facility can sound like a cold, impersonal place for patients who only has the desire to be out as soon as possible. CM provides an opportunity to create events that spark camaraderies, such as raffles, games, and contests.

 

In this way, individuals undergoing treatment have something to look forward to, not just outside of the rehab center but also within the course of their inpatient stay. Additionally, the spirit of camaraderie is also important in the workplace, especially for addiction treatment employees. Dealing with the mental health struggles of others can be draining, but CM also benefits employees by instilling positive feelings.

A sense of unity

Aside from support groups, CM programs can also promote a sense of unity among rehab participants. As they join the voucher programs, contests, or raffles, they get a sense of ‘belongingness’ as others participate in these events as well. 

 

This type of group cohesion motivates them to stay sober and complete their addiction treatment goals without feeling isolated in their journey. There are many studies that point to the importance of receiving peer support in addiction recovery. CM can be one of the dynamic ways people can encourage each other to remain substance-free during the course of their treatment.

Instilling a lasting habit

Sometimes, abstinence can be achieved not by looking at a bigger picture, but rather by taking small habitual steps. CM is one of the methods that can be used for individuals who would rather take these little steps towards sobriety.

 

By completing tasks and getting incentives, they are instilling a habit of sobriety that lasts beyond the confines of a rehab center. Even when the prizes and contests are gone, there is a better chance for people to remain sober because of the positive habits they cultivated within the CM intervention program.

What should be done to increase awareness of Contingency Management interventions?

Here are some ways that researchers, rehab facilities, and professionals can increase the awareness of CM methods:

 

    • Increasing studies that prove the effectiveness of CM: There are small scale studies that show how CM can be effective in various rehab contexts, but they are not as numerous as the research done on other addiction treatment methods. By putting in more work on creating journal studies regarding CM, more light will be shed on how these methods can be effective in substance abuse treatment.
    • Placing CM interventions as part of the standard programs: Some rehab centers for alcohol and drugs have blended programs, where people can participate in larger groups rather them receiving one-on-one treatment. By putting some CM principles in these blended activities, rehab facilities can take note of its effectiveness in achieving sobriety goals.

 

  • Discussing CM methods with key persons: Addiction treatment professionals also have the responsibility of understanding the best practices in their field. Once armed with knowledge, professionals can suggest and discuss these methods to program facilitators and head managers to explore how they can be implemented.

 

Contingency Management: A promising method in need of attention

Indeed, Contingency Management can be a powerful tool in increasing success rates of addiction treatment. The reasons stated above and the supporting studies indicate that CM methods should be more widely used in rehab facilities. The principles of CM interventions holds a bright promise both for professionals and patients in substance abuse treatment.

 

Sources:

  • Drugabuse.gov – “Contingency Management Interventions”.
  • Cloudfront.net – “Something of value: The introduction of contingency management interventions into the New York City Health and Hospital Addiction Treatment Service”.
  • Usatoday.com  – “3 Reasons Why Team Camaraderie in the Workplace is Important”.
  • Onlinelibrary.wiley.com  – “Effectiveness of a peer-support community in addiction recovery: participation as intervention”.
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