Contingency Management: Financial Incentive To Stay Sober

Contingency Management: Financial Incentive To Stay Sober


To deter users from abusing drugs, there needs to be a reinforcer that is more potent than drugs. Contingency Management is the means of curbing drug abuse with the most potent reinforcer known to humankind- Money!

Table of Contents

What Is Contingency Management?

Contingency Management is a behavioral therapy that helps an addicted individual to redirect from addiction to positive behavior. It is an effective treatment principle that grants rewards and incentives to patients who practice positive behaviors. Positive behaviors such as abstinence from drug use can make individuals eligible for incentives. 

How Much Does Contingency Management Pay?

The average CM program offers between three hundred to eight hundred dollars within a time frame of twelve to sixteen weeks. But, there are two means through which such incentive-based interventions function - Voucher based Reinforcement and Prize Incentive Contingency Management.

Voucher based Reinforcement

The Voucher-Based Reinforcement or VBR is for adult drug users. Patients who rely on opioids, cocaine, or methamphetamine benefit from the VBR. In VBR, patients receive vouchers for every sample of their urine that is free of drugs. The voucher would have a monetary value exchanged for services and goods such as food or movie tickets. The goods and services in VBR are consistent with a drug-free life. 

At the beginning of a VBR program, the value of the voucher would be low. Voucher value increases as the number of drug-free urine samples increases. Samples that test positive would reset the value to the initial low value.  

Prize Incentive CM

Prize incentives are like VBR, with an exception - Cash replaces Vouchers. Price incentive programs last for three months. Participants who submit samples that test negative for drugs during a program can draw their random prizes from a bowl. Their luck could enable them to win prizes between one or hundred dollars. 

In prize Incentives, participants receive chances to draw their prizes based on targets. Number of draws increases with consecutive negative samples and attendance in counseling sessions. 

The Prize Incentive system, on average, could give about $360 to a participant. In comparison, the VBR could provide about $1,200 during the CM. 

Contingency Management Therapy

CM assists individuals to decrease their dependency on drugs. CM took form in the 1960s based on the works of the psychologist BF Skinner. CM involves a trained therapist using reinforcement strategies. The therapist aids individuals in their drug recovery process.

CM is often clubbed with other therapeutic approaches such as Cognitive Behavioural Therapy (CBT). The core tenet of CBT is that subjects are likely to repeat positive behavior if their behavior receives a reward. Researches, such as Ginely MK's quantitative meta-analysis of long-term effects of CM, shows that it can help people increase abstinence. 

Contingency Management Therapies also help people remain in rehab, increase their participation while in rehab, and improve their rehabilitation experience. 

Contingency Management Intervention

CMs is a behavior modification intervention. In CM, the desired behavior is reinforced through extrinsic motivators. Extrinsic motivators include incentives for abstaining from drugs. As methadone maintenance treatments reduce the dependence on opioids, CM interventions reduce one's dependencies on drugs. Contingency management is a psychosocial intervention that gets clubbed with treatment interventions. 

What Is The California Bill for Contingency Management?

The California CM bill or SB110 is a bill that seeks to expand the scope of services related to substance use disorders. The bill seeks to put in place Contingency Management as an optional benefit under these services. California could become the first state in the US to have CM under its substance abuse services.

The decision to include CM into its services came as a reaction to the rising Methamphetamine use in California. The number of deaths due to the overdose of Meth increased by 79% in Los Angeles County in 2019 compared to the past year. 

Isolation from the pandemic is one reason associated with the exponential rise of Meth among users. There are medications to treat opioid addictions. But, the FDA has not approved any drugs against methamphetamine. The absence of FDA-approved drugs leads researchers to conclude that the new bill can help achieve and maintain sobriety.

Examples of Successful Contingency Management

  • The California Bill includes Contingency Management partly because of other successful CMs.
  • The US Department of Veterans Affairs allows a form of VBR. Every week, drug users draw prizes from a fishbowl if they test negative. The duration of sobriety determines the amounts of draws they receive. The program which launched in 2011, reports ninety-two percent negative rates in drug testing over the program course. 
  • The AIDS Foundation of San Francisco offers an intervention in the form of gift cards. The gift cards offer rewards of value ranging from 300 to 400 dollars over twelve weeks. 63% of users under the program completely stopped the use of Meth in 2019. 19% of meth users reduced their use.
  • The success stories of such isolated implementations of CM can encourage the implementation of SB110. Once SB110 is effective in California, other states might follow up. 
  • Takeaway

    The goal of Contingency Management is to guide drug users to a position in life wherein they no longer need the cash from the program. CM service might or might not work for everyone who opts for it. Yet, the odds of long-term recovery increases if an individual maintains sobriety. In this sense being sober during the twelve to a sixteen-week interval of the program can do wonders for people signing up for CM programs.

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