Contingency Management Therapy

Contingency management therapy is an approach sometimes used in addiction treatment to help mitigate substance abuse and drug-related behaviors. 

Contingency management (CM) was developed in the 1960s based on the premise of operant conditioning (also known as the three-term contingency) as defined by Harvard psychologist, BF Skinner.

With a trained therapist employing reinforcement-based strategies to encourage abstinence during the addiction recovery process, contingency management treatments. 

Studies show that CM can be effective for those withdrawing from cocaine. Contingency management is also proven effective for treating those dependent on marijuana, alcohol, and multiple substances.

 

What is Contingency Management in Counseling?

Contingency management behavior therapy is a form of behavioral therapy grounded on operant conditioning. 

Operant conditioning is also known as instrumental conditioning or the three-term contingency. This method of learning holds that the consequences of a response dictates the probability of that behavior being repeated. 

The three-term contingency is a pivotal aspect of behavioral psychology. Also known as behaviorism, behavioral psychology was popularized in the 1900s and is still widely used today. Behaviorism states that all behaviors are learned through conditioning – through interaction with the environment. Per behaviorism, behavior is nothing more than a response to environmental stimuli, and as such can be manipulated.

The three-term contingency expresses the relationship between behavior, consequences, and environmental context. 

When applied in counseling, CM holds that:

1. Positive behaviors that are rewarded are more likely to continue at increased intensity, frequency, and duration.
2. Negative behaviors that are punished are more likely to continue at reduced intensity, frequency, and duration.
3. Behaviors that receive neither reinforcement or punishment will be reduced until they are eliminated.

If you engage in operant conditioning or contingency management, you are rewarded for positive behaviors. This reinforcement means you are liable to repeat those behaviors. Negative behaviors, on the other hand, should reduce in frequency.

When applied in the context of addiction recovery, contingency management therapy delivers rewards for desired, healthy behaviors – clean drug screens, for instance. Reinforcement is the driver of CM, but the withholding of privileges or introduction of sanctions can be used if you engage in undesirable behaviors.

Contingency management is proven effective for the treatment of a variety of issues, including: 

• Substance abuse (stimulants, opioids, marijuana)
• Alcohol abuse
• Nicotine addiction
• Impulsive behaviors
• Defiance

Every person engaging with therapy has different needs and CM can accommodate most needs with some small tweaks. 

Contingency management can be effective as a standalone treatment or it can be delivered in combination with various treatment styles, such as: 

• Motivational interviewing
• Medication management
• CBT (cognitive behavioral therapy)
• Medication maintenance programs

Per operant conditioning, many behaviors can be learned through this process, while at the same time existing behaviors can be modified through rewards and punishments.

 

Contingency Management Therapy Definition

The definition of contingency management is grounded on a behavioral principal: when behaviors are rewarded and reinforced, they are more likely to reoccur. 

Contingency management programs will differ, but they all follow these guiding principles:

• Target behaviors: With your therapist, you will identify positive behaviors to be increased and negative behaviors to be reduced. Positive behaviors might include attending therapy sessions, peer-support meetings, and working on your treatment goals. Negative behaviors could include anything related to substance use, from buying to using addictive substances.
• Target population: Financial constraints mean that many rehab centers only offer contingency management to certain patients or groups of patients. If you have a severe addiction to heroin or meth or a co-occurring mental health disorder, you may be a suitable candidate for CM.
• Reward: Your treatment team should ensure that rewards are likely to motivate you. Rewards may be dispensed at a specified rate or a variable rate.
• Duration of therapy: There is no fixed timeline for CM. If you are aiming for long-term sobriety, it is worth pursuing contingency management therapy for as long as it proves beneficial. When you complete a course of CM, you should ensure that you have robust relapse prevention strategies in place.

What is an Example of Contingency Management Therapy?

Contingency management therapy for substance abuse uses two primary incentives:

1. Vouchers
2. Cash

VBRT (voucher-based reinforcement therapy) provides you with vouchers every time you give a clean urine sample. You can exchange the vouchers for goods or services like: 

• Clothes
• Food
• Restaurant meals
• Movie tickets
• Bus passes
• Books
• Electronics
• Gas

With VBRT, vouchers typically start off low in value, gradually increasing in line with repeated good behaviors. Negative behaviors like failing a drug test will reset the voucher value. 

PBCMT (prize-based contingency management therapy), by contrast, rewards patients for positive behaviors with cash prizes. This therapy unfolds over three months. Following weekly drug screens or activities related to recovery goals, you enter a draw for small cash prizes. These awards range from $1 to $100, increasing in line with repeated good behaviors. As with VBRT, the prize money resets if you fail to meet goals or if you fail drug tests.

Here are some common examples of contingency management applied to substance abuse treatment:

• Testing negative for drugs or alcohol
• Attending therapy sessions
• Applying for a job
• Taking medication consistently for one week
• Demonstrating altruistic behaviors

Therapy at The District Recovery Community

Here at The District, we specialize in the gender-specific outpatient treatment of addictions and mental health conditions. 

Our men’s rehab and women’s rehab programs are available at the following levels of intensity: 

• OP: standard outpatient program offering 2 or 3 hours of weekly therapy.
• IOP: intensive outpatient programs offering 12 to 15 hours of weekly therapy.
• PHP: partial hospitalization programs offering 30 to 35 hours of weekly therapy.

Whatever program makes the best fit for your needs, you’ll have access to the following evidence-based therapies: 

• MAT (medication-assisted treatment)
• Psychotherapy (talk therapy like CBT or DBT)
• Contingency management therapy
• Counseling (individual and group)
• Family therapy
• Holistic therapies

Once you complete your treatment program here at The District, you can either step down to a less intensive form of treatment or transition directly into sober living. 

Get started by reaching out to the friendly team today at 844.287.8506.