Contingency Management (CM) treatment, also often referred to as motivational therapies, is a type of behavioral therapy offered at many treatment facilities. CM provides a patient with rewards when they achieve certain desired behaviors and disciplinary measures or withholding of privileges when the patient engages in undesirable behaviors.
Most CM treatment programs last three months or longer and have been shown to be effective in treating both alcohol and drug addictions. CM can be used as a standalone treatment or in conjunction with other treatment styles. Some treatments commonly combined with CM are cognitive-behavioral therapy, medication management, medication maintenance programs for people in recovery, and motivational interviewing.
The above outlines the basic terms with which we can define CM. Now let’s take a look at the theoretical framework that the method is based on. CM can trace its roots back to a psychological principle called behaviorism, popularized in the mid-twentieth century.
The concept can be broken down into three simple points:
- Behaviors that are rewarded are more likely to continue and continue with increased frequency, intensity, and duration.
- Behaviors that are punished are more likely to be reduced in frequency, intensity, and duration until they are eliminated.
- Behaviors that are ignored, given no reinforcement, or no punishment will be reduced until eliminated.
CM has a proven track record in many settings where operant conditioning programs are used. People can benefit greatly from the structure and expected responses of controlled positive and negative reinforcement. Schools, prisons, behavioral health centers, and residential treatment facilities have employed these methods.
The most effective implementation of CM creates an environment for patients to choose to move away from substance use. In order to reach this point, people in recovery are rewarded for attending treatment, maintaining expectations of the program, and avoiding unwanted behaviors. As those people continue to abide by the parameters of their treatment, the chances of earning rewards grows. Punishments can work to reduce undesirable behaviors, but treatment facilities using a CM program tend to use consequences sparingly. The goal of positive reinforcements (and occasionally negative reinforcements) is to provide an outcome that is equal or will outweigh the perceived reward associated with substance abuse.
7 principles to guide treatment govern any CM program:
- Target behavior. What are the negative (substance buying, substance use, etc.) and positive (compliance with therapy sessions, establishing appropriate relationships within the facility, etc.) target behaviors?
- Choice of target population. Who is most likely to benefit from CM? Usually newer clients or those with low rates of success with other treatment methods.
- Choice of reinforcer. What positive reinforcement will work best as a reward for a particular client? This reward is something that a therapist and client will work together to determine.
- Incentive magnitude. What is the balance between what’s practical and what is rewarding? Treatment facilities do not have unlimited resources.
- Frequency of incentive distribution. How often will a negative or positive behavior be reinforced?
- Timing of incentive. When will a reward be delivered after a desired behavior is completed? Ideally, positive reinforcement will come immediately afterwards in order to build a strong association between the behavior and the reward.
Duration of intervention. How long should the CM treatment continue? The goal of CM is always to foster a desire for sobriety that will continue after the rewards are removed.
There are, of course, some limitations to CM. One study conducted by The Journal of the National Institute on Alcohol Abuse and Alcoholism reports that: “Although CM is generally effective… The use of CM in alcoholism treatment may be limited, however, by the technology available to test for alcohol use” (126). Remember that CM relies on time sensitive procedures to ensure that clients have reached the goals associated with desirable behaviors. Because alcohol tests are only reliable up until about 12 hours after use, the results of those tests can be inconclusive in determining if a client has achieved the agreed upon goal.
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