Author: Ruben Bermea, LPC

If you or a loved one is experiencing opioid addiction and looking for effective treatment, you may want to consider an approach called contingency management. Contingency management for opioid use disorder is shown to be an effective treatment option.¹

In this Article:

• What Is Contingency Management?
• How Does Contingency Management Work?
• Who Can Benefit from Contingency Management Interventions?
• How Can I Find a Treatment Program That Offers Contingency Management?

What Is Contingency Management?

The contingency management definition offered by the National Institutes of Health describes this therapeutic approach as a set of principles that “involve giving tangible rewards to reinforce positive behaviors,” such as abstinence and staying involved in treatment for an extended period.²

Contingency management in opioid addiction uses a planned system of rewards that reinforces recovery-oriented behavior. The principles of contingency management come from research in behavioral analysis.⁴ This body of research explores positive reinforcement or the idea that specific behaviors will increase when rewarded and will decrease or stop when not rewarded.¹

Treatment programs that use contingency management for opioid use disorder offer tangible rewards, such as vouchers and prizes, to individuals who meet established goals.^1,2 When individuals do not meet their goals, they are not punished; rewards are simply reduced or withheld until the goal is met.¹

How Does Contingency Management Work?

Opioid addiction can create a continuous cycle of neurochemical reward and negative physical, psychological, emotional, and social consequences that can lead to severe problems for a person’s health and overall well-being.^1,3 Contingency management seeks to compete with the positive neurochemical reinforcement individuals experience when misusing opioids.¹

By offering immediate incentives at a frequent rate, contingency management programs can help people feel rewarded for engaging in behaviors that improve their health and promote recovery from addiction.¹

Incentives in Contingency Management

The types of rewards offered by contingency management can vary depending on the program and individuals’ personal needs.¹ People may have the option to choose their rewards, depending on the type of program they engage in.

Incentives offered by a program that uses contingency management for opioid use disorder may include:^1,2

• Cash prizes
• Tickets to events
• Vouchers that participants can redeem for other prizes
• Goods
• Services
• Preferred items
• Affirming and supportive messages

Vouchers are one of the more popular forms of contingency management.^1,2 In contingency management for opioid use disorder, vouchers can scale in value depending on how effectively a person achieves their recovery goals or the perceived difficulty of a goal.¹ For example, the longer a person attends sessions or remains drug-free, the higher the value of the voucher a person receives.

Other programs may take a “prize-based” raffle approach to incentives, giving people a chance to draw a ticket for a random prize when they achieve a goal.¹ The number of draws a person can take may correlate to how long an individual maintains their recovery goals. When a person misses a goal, they may receive fewer draws.

Goals in Contingency Management Programs

Specialists who use contingency management for opioid use disorder treatment may break a person’s recovery goals down into a series of steps.¹ This can create additional opportunities to receive incentives or reinforcement. Incentives for consistently achieving small goals can help a person maintain motivation for recovery. More important goals may net higher incentives.

Contingency management in opioid addiction treatment rewards specific behaviors or meeting recovery goals, such as:¹

• Consistent engagement in treatment activities
• Keeping important appointments
• Attendance at mutual-support or peer-led groups, like Narcotics Anonymous (NA)
• Achievement of recovery-focused personal goals
• Getting or keeping a job
• Educational accomplishments
• Staying compliant with medication
• Maintaining abstinence from opioids or other substance use
• Providing a drug-free urinalysis result
• Maintaining lifestyle activities that promote sobriety

The goals and incentives offered by treatment programs can be adapted to meet personal and addiction recovery goals.¹ Talk with your program of choice to see how they approach reinforcing recovery.

Who Can Benefit from Contingency Management Interventions?

A growing body of research demonstrates that contingency management in opioid addiction recovery can be effective for diverse populations in different treatment settings.^1,3,6 For example, studies show that contingency management offers benefits to Hispanic and African-American people and to individuals of diverse socio-economic backgrounds.⁶ Research has also shown the benefits of contingency management when treating individuals who received methadone treatment or opioid detoxification services at the same time.⁴

Overall, contingency management appears to work best for individuals who struggle with sobriety and opioid misuse at the start of treatment.^1,5 It may not be needed or as effective for people who have already discontinued their drug use.¹

Contingency management for opioid use disorder treatment can combine well with a multitude of treatment approaches, including some types of behavioral therapy and medication-based interventions.¹ The effectiveness of combined approaches will depend on various factors, including a person’s needs.

New developments in technology, including internet-based programs and mobile phone apps, can offer greater access to contingency management programs.⁶ These interventions can also offer potential cost savings for people who use this technology.⁶

How Can I Find a Treatment Program That Offers Contingency Management?

Finding a treatment program for opioid use disorder is an important choice in one’s recovery.¹ Knowing your personal preferences, the benefits of different approaches, and how a recovery program will help you in the long term can inform your choice of a treatment program. Getting matched with the right program, at the right level of care, and with a clinician who helps you feel supported can have tremendous effects on your long-term motivation for recovery.

Everyone has their own needs in life and recovery.¹ This means that no treatment program can offer a “one-size-fits-all” approach. To experience the benefits of contingency management for opioid use treatment, ask the programs you are considering if they offer these interventions.

If you would like support in exploring programs that offer contingency management for opioid use recovery, call 800-934-1582(Who Answers?) today to speak with a treatment specialist about the choices available to you.

References

1. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: A guide for professionals (2nd ed.). The Guilford Press.
2. National Institute on Drug Abuse. (2020, June 1). Contingency management interventions/motivational incentives (alcohol, stimulants, opioids, marijuana, nicotine). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
4. Petry N. M. (2018, January 2). Contingency management: What it is and why psychiatrists should want to use it. The Psychiatrist, 35(5), 161-163.
5. Rash, C. J., Stitzer, M., & Weinstock, J. (2016, September 28). Contingency management: New directions and remaining challenges for an evidence-based intervention. Journal of Substance Abuse Treatment, 72, 10-18.
6. McPherson, S. M., Burduli, E., Smith, C. L., Herron, J., Oluwoye, O., Hirchak, K., Orr, M. F., McDonell, M. G., & Roll, J. M. (2018, August 13). A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. Substance Abuse and Rehabilitation, 9, 43–57.