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Defining Contingency Management in Psychology
If you have been asking yourself, “What is contingency management therapy?” you are in the right place. Another name for this methodology is “motivational incentives.” It offers incentives or rewards when the individual engages in healthy or desirable behaviors.
This mental health treatment method is often used in psychology and addiction treatment in California because it allows the patient to reach short-term and long-term goals with a tangible reward. This causes a positive reinforcement loop in the brain, which will help reinforce long-term good habits.
So, what is contingency management in psychology? It is based on operant conditioning (a learning process associated with B.F. Skinner, a famous psychologist from the 1930s), meaning when a person behaves “correctly” or achieves a certain goal, they receive a reward, which will then strengthen the brain’s will to continue doing the behavior, making it more likely for the person to want to do it. The reward size will often become bigger the longer the behavior motivates the patient.
Voluntary actions that are rewarded are more likely to be repeated, and when it comes to substance abuse, there is a large part of the psychological addiction. By working to reinforce actions that result in healthy living and abstinence, psychologists can help patients overcome these psychological aspects of their substance use disorder, making it easier to stay sober long-term.
Key Contingency Management Techniques
Common contingency management techniques include:
- Choice and preference assessments to find out what types of rewards the patient will respond to best
- Contracts between patients and therapists, ensuring everybody agrees to and understands the terms of the agreement and when prizes will be awarded
- Family and community reinforcement, to make sure everybody is on the same page, rearranging the person’s life so that abstinence from substance use or negative behaviors is rewarded at home, work, school, and in the community
- The token economy method provides tokens that can be exchanged for goods when a healthy behavior is displayed, which helps patients visualize their progress and helps them to accept delayed reinforcements (which can minimize impulsive actions like substance use in the future)
Real-World Contingency Management Examples
Some contingency management examples include:
- A person addicted to cocaine who receives rewards for participating in their recovery activities regularly will be more likely to continue showing up to meetings
- Somebody rewarded for taking their psychiatric medication as prescribed every day will be less likely to forget or skip their meds, even if they don’t feel like taking them.
- Somebody who shows up and participates in every scheduled group therapy meeting will get their name put into a draw to win a prize, making them more likely to want to come to the group, even on difficult days.
Contingency Management and Drug Addiction
The American Psychiatric Association (APA) mentions that contingency management drug addiction voucher programs are effective, with treatment centers offering vouchers for services or retail items after the patient provides a urine sample testing negative for drugs. These vouchers increase in value the longer the patient stays sober. This program is incorporated into a holistic treatment plan with counseling, behavioral therapy, and case management services, helping people with substance use disorders gain the skills needed to live the life they want to live.
Contingency management addiction treatment is often more expensive than other types of treatment. Still, it is more effective overall in treating those with addiction, including those with severe mental health disorders and others who are challenging to treat, saving the community long-term money.
How It Works
The concept of contingency management is simple. An agreement is drawn up between a patient and a therapist or treatment specialist, in which certain rewards are offered at specific milestones or timelines upon the condition that the patient fulfills a particular obligation. For example, a person with an addiction will undergo routine drug screenings and, after each clear one, receive a token, voucher, or benefit. If their screening is not clear, they do not receive the reward.
This type of conditioning is usually given along with other evidence-based therapy methodologies, holistic treatment programs, and case management services. It helps to reinforce healthy decisions. Patients will often enjoy the process and are often excited to participate. They are given the daily choice to decide their own fate while learning to take responsibility for their actions.
Future and Challenges of Contingency Management
Some challenging aspects of implementing this type of therapy are:
- Doubt from naysayers, who believe it is a waste to reward “normal” behaviors
- Clinicians who do not stick to a predictable reward schedule or escalate the value of reinforcers jeopardize the program’s effectiveness
- Issues with funding, as it is more expensive than most treatments
Within psychology and addiction treatment, contingency management is seen as effective overall. It is endorsed by entities like the Department of Veteran Affairs, the National Institute on Drug Abuse (NIDA), and the Substance Abuse and Mental Health Services Administration (SAMHSA).
Frequently Asked Questions About Contingency Management Therapy
What is the primary aim of contingency management therapy?
The aim is to reinforce wanted behaviors while eliminating unwanted or unhelpful behaviors. For addiction, the goal is to stop substance use.
How is contingency management used in psychology?
Contingency management reinforces positive behavioral changes using tangible rewards like vouchers, privileges, or tokens.
Can you give examples of contingency management techniques?
Some examples of contingency management include providing vouchers or tokens when a person addicted to drugs produces negative urine test results, when a veteran with PTSD attends therapy sessions, or when a patient actively participates in group sessions. These rewards give the patient a positive reinforcement that will make them want to repeat the action repeatedly, resulting in consistent, healthy behavior.
What kinds of addiction can contingency management treat?
Contingency management is often used to treat addiction to alcohol, cocaine, crack, benzodiazepines, methamphetamine, opioids, and nicotine, among other substances. It is often used as part of a program that incorporates different types of treatment, like behavioral therapy, medical treatment protocols, and case management services, as a whole-patient approach to treatment.
Are there any risks or downsides to using contingency management therapy?
Besides an additional financial expense and the logistics of keeping reinforcers available as needed, one of the significant risks of using this type of therapy is the possibility of inconsistencies in frequency, magnitude, and escalation of rewards by therapists. When not done correctly, the risk of relapse in patients increases.
Is contingency management therapy evidence-based?
It is an evidence-based substance use disorder treatment supported by objective scientific research.
How do I find a qualified contingency management therapist?
To find a contingency management therapist in your area, you can try online searches with the words contingency management therapist and your city name in quotations. You may also wish to look at the American Psychological Association website’s psychologist locator or browse the California State Psychological Association website.
California Rehab Campus offers a variety of addiction treatment programs, including contingency management. To learn more about inpatient addiction treatment programs, call California Rehab Campus at 949-867-4937 to speak with an expert.