What Is Contingency Management?
Contingency management is a treatment modality that has been shown to work well in helping people recover from substance use disorders. It plays on an important psychological principle, and the notion of contingency management can be incredibly helpful in illuminating how people behave the way they do and how that behavior might be altered.
The main idea is that those attempting to abstain from problematic substance use are given rewards or prizes to positively reinforce the progress they make during their recovery journey.
Potential benefits of contingency management are wide-ranging; according to an academic paper published by the Royal College Of Psychiatrists, contingency management can aid in, “increasing abstinence in individuals with dual diagnoses, encouraging attendance in mental health treatment settings, enhancing adherence to psychiatric medications, reducing weight, and improving exercise.”
Below, the mechanisms behind contingency management will be explained more fully — but first, it may be helpful to see some examples of what kind of prizes might be given to individuals in recovery.
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What Kind Of Prizes Might Work?
The theory behind contingency management holds that essentially any prize which has value to the recipient could effectively be used in the course of treatment. With that said, some specific prizes may include but not be limited to:
- Food vouchers
- Gift cards
- Movie tickets
- Sporting goods
- Clothing items
Each individual treatment center that offers contingency management may take a different approach in regard to which prizes are offered and what conditions must be met in order to earn them. One common condition is passing a urine test, which provides a relatively reliable way to ascertain that drugs and alcohol have indeed been abstained from.
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Why Does Contingency Management Work?
Contingency management leverages the principles of “operant conditioning,” which is essentially the idea that individuals can be trained to act in certain ways if they are rewarded or punished following either compliant or aberrant behavior. Operant conditioning contrasts with “classical conditioning” which, unlike operant conditioning, concerns itself with involuntary responses (as in the case of the proverbial Pavlov’s dogs.)
Most people are familiar with the concept of giving a dog a treat or a loving tone if the animal submits to a given request, or with using a sterner tone or withholding affection if the pet does not comply; the same principle (operant conditioning), which was studied heavily by psychologist B.F. Skinner, can also apply to human beings.
The proof of contingency management in action can be seen in the functioning of modern-day technology, including many social media apps. Repeated experimentation to see which rewards and punishments users respond to forms the basis of the way much of today’s technological tools work. According to a piece published in Behavioral Scientist, “The shape and color of the buttons you press, the timing of each notification you receive, and the content of every piece of information that reaches you have often been curated through this data-driven process of mass experimentation.”
What Are Contingency Management’s Flaws?
Contingency management may not in and of itself be a flawed concept; indeed, one academic paper described one of the obstacles to the approach as being that not enough mental health providers know about the treatment option — along with the fact that, potentially, they may have “ideological concerns” over its use.
Those ideological concerns may vary based on the practitioner; one possible risk to contingency management is that giving someone prizes (or punishments) in exchange for behavior can cause that individual to no longer be internally motivated to take action for their own reasons (like a felt sense of pride, accomplishment, belonging, or competency).
As an academic paper published in Social Science & Medicine found, “Motivation crowding studies have demonstrated that external interventions can harm effort and performance through crowding out of intrinsic motivation, when interventions are perceived as lack of trust.”
In other words, if those in recovery feel that they are only being given (or denied) prizes because their caregivers do not trust them to act appropriately on their own, those in recovery may adopt a sense of “learned helplessness” — the philosophy that the outcomes of one’s actions are beyond one’s control, and therefore there is no reason to take any action at all.
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How Can You Claim Your Prize?
It’s possible there’s a treatment center near you that offers a contingency management approach; if you have been unable to abstain from problematic use of drugs or alcohol and want to experiment with a new modality, you may stand to gain from seeing how contingency management fits you.
In addition, other approaches to treatment (like alternate forms of therapy, certain kinds of medication, and psychosocial support like the kind provided by support groups) may be effective ways to not only enhance the effectiveness of contingency management but also develop a fuller arsenal of coping strategies to combat addiction and improve mental health.
Without a doubt, prizes like the ones listed above may be in store — but even if you’re not yet sure about the best way to tackle addiction and/or a mental health disorder, there’s something you can do right now to gain more clarity and make progress toward your eventual goal.
You can contact a treatment provider, right now, for free. By so doing, you may be able to learn about rehab centers near you, available treatment options, and the steps you could take to move toward a healthy and lasting recovery.
Will Henken earned a B.A. in Advertising and Public Relations from the University of Central Florida. He has had his work published in the Orlando Sentinel, and has previous experience crafting copy for political action committees and advocacy groups dedicated to social justice. Addiction and mental health are personal subjects for him, and his greatest hope is that he can give a helping hand to those seeking healthy and lasting recovery.
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Reviewed by Certified Addiction Professional:
David embarked on his journey into sobriety in June of 2005, which led him to his current career path as a Certified Professional Addiction Recovery Coach in private practice in Greater Nashville. David is also a public speaker and the author of two books. David is cohost of the weekly Positive Sobriety Podcast, as well as being a frequent contributor to various articles and recovery based materials. As a member of the National Association of Alcohol and Drug Abuse Counselors (NAADAC), David works closely with area treatment centers, recovery orientated nonprofit organizations, as well as being a keynote speaker for various recovery-focused events.
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- Royal College Of Psychiatrists. (2011). Contingency Management: What It Is And Why Psychiatrists Should Want To Use It. Retrieved on December 15, 2021, from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083448/
- National Institute On Drug Abuse. (2018). Contingency Management Interventions/Motivational Incentives. Retrieved on December 15, 2021, from: https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/contingency-management-interventions-motivational-incentives
- Psychiatric Times. (2002). Contingency Management In Addiction Treatment. Retrieved on December 15, 2021, from: https://www.psychiatrictimes.com/view/contingency-management-addiction-treatment
- Society For The Study Of Addiction. (2019). What Is… Contingency Management? Retrieved on December 15, 2021, from: https://www.addiction-ssa.org/knowledge-hub/what-is-contingency-management/
- HealthAffairs. (2020). Contingency Management: A Highly Effective Treatment For Substance Use Disorders And The Legal Barriers That Stand In Its Way. Retrieved on December 15, 2021, from: https://www.healthaffairs.org/do/10.1377/hblog20200305.965186/full/
- Social Science & Medicine. (2018). Can External Interventions Crowd In Intrinsic Motivation? A Cluster Randomised Field Experiment On Mandatory Accreditation Of General Practice In Denmark. Retrieved on December 15, 2021, from: https://www.sciencedirect.com/science/article/pii/S0277953618303319
- U.S. Department Of Veterans Affairs. (2020). Contingency Management – VA Homeless Programs. Retrieved on December 15, 2021, from: https://www.va.gov/HOMELESS/nchav/resources/interventions/contingency-management.asp
- Behavioral Scientist. (2018). The 21st Century Skinner Box. Retrieved on December 15, 2021, from: https://behavioralscientist.org/21st-century-skinner-box/