Contingency management therapy (CMT) is an approach that involves giving patients tangible rewards to reinforce positive behaviors such as abstinence. Studies have shown that incentive-based interventions are very effective in driving success in rehabilitation and recovery programs.
Voucher-based reinforcement (VBR) is a type of CMT that also motivates substance abusers to get vacated and more functional in the society. In this system, the patient receives a voucher/coupon for every drug-free urine sample provided, which can be exchanged for food items or other goods. The vouchers increase in value as the addict continues to live a drug-free lifestyle. This has been shown to be an effective method in promoting abstinence from opioids and other drugs while living in the community.
Other types of CMT include cash incentives where the addict gets cash prizes for every drug-free urine or breath tests. It could be a draw prize as well. Other types of accepted entries include attending counseling sessions and completing weekly goal-related activities. There are some concerns that such methods may promote further drug-seeking behavior by faking tests, etc. Another concern is that it could promote gambling, which is a problem because pathological gambling and substance use disorders can co-occur. However, outcomes studies of these types of CMT programs have shown promising results and no significant increase in gambling behavior.
There have been numerous studies that show the effectiveness of CMT programs. One study published in 2000 study evaluated the efficacy of contingency management (CM) procedure that provided opportunities to win prizes as reinforcers. They compared alcohol addicts who were placed in two groups – one with standard treatment and the other with standard treatment plus CMT. Cash prizes were given for submitting negative Breathalyzer samples and completing steps toward treatment goals. The results showed that 84% percent of the CM participants were retained in treatment for an 8-week period compared with 22% who were on standard treatment participants only. Furthermore, by the end of the treatment period, 69% of those receiving CM were still abstinent, but 61% of those receiving standard treatment had used alcohol. These results support the efficacy of CMT.
Another study published in 2002 evaluated the efficacy of a low-cost CMT in reducing concurrent cocaine and opioid use among patients on methadone treatment. They randomly assigned 42 patients to two groups – one on 12 weeks of standard treatment and the other on standard treatment plus CM. The CM method used was a cash draw prize for submitting samples negative for cocaine and opioids. It was observed that patients in the CM group achieved longer durations of continuous abstinence than patients in the standard treatment condition, and these effects were maintained throughout a 6-month follow-up period.
There are many such studies that validate CMT as a viable, effective and feasible method when used on substance abuse patients in the community setting in combination with standard treatment.
