Contingency Management (or sometimes referred to as Motivational Incentives) represents one of the most effective ways to enhance motivation among substance abusers by leveraging their personal strengths and focusing on positive gains.
Contingency Management (CM) is a scientifically-based treatment approach grounded in the principles of behavior management and cognitive-behavioral therapy that provides incentives for abstaining from drug abuse changing thinking patterns, and improving parents’ coping skill. Techniques involved in this treatment include positive reinforcement for drug abstinence and negative consequences for returning to drug use, with the emphasis on positive reinforcement and the celebration of success. This celebration of success helps the client remain motivated to change and provides a positive and welcoming treatment environment.
CM is Supported by Leading Agencies as being an Effective Treatment
National Institute on Drug Abuse: Principles of Drug Addiction Treatment
Surgeon General’s Report on Addiction
Blending Initiative/NIDA/SAMHSA: Promoting Awareness of Motivational Incentives
Addiction Technology Transfer Center: CM Part 1: An Evidence-Based Approach to Positive Change
Addiction Technology Transfer Center: CM Part 2: The Founding Principles
Addiction Technology Transfer Center: CM Part 3: Principle-Based Implementation
Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide
CM-YA Target Population
Contingency Management for Youth Addiction (CM-YA) is intended for Youth ages 12-17 who are:
- Exhibiting early abuse, abuse, or dependence on drugs or alcohol.
- Experiencing a disruption in their life and development due to their drug or alcohol use which can include arrest, probation, poor school attendance, or performance and/or difficulties in their home life
- Living with a responsible parent or caregiver who has a genuine interest in their well-being and who has the ability to collaborate on and enforce the behavior plan and drug screen protocol
- Youth with co-occurring problems (depression, delinquency) are appropriate for CM-YA assuming that those problems can also be addressed in the treatment.
CM-EA Target Population
Contingency Management for Emerging Adults and Adults (CM-EA) is intended for young adults ages 18-26+ who are:
- Exhibiting early abuse, abuse, or dependence on drugs or alcohol.
- Experiencing a disruption in their life and development due to their drug or alcohol use which can include arrest, probation/parole, poor school/work attendance, or performance and/or difficulties in their home life or relationships.
- Emerging adults with co-occurring problems (depression, anxiety, etc.) are appropriate for CM-EA assuming that those problems can also be addressed in the treatment.
CM-A Target Population
Contingency Management for Adults (CM-A) is intended for adults ages 27+ who are:
- Exhibiting early abuse, abuse, or dependence on drugs or alcohol.
- Experiencing a disruption in their life and development due to their drug or alcohol use which can include arrest, probation/parole, poor school/work attendance, or performance and/or difficulties in their home life or relationships.
- Adults with co-occurring problems (depression, anxiety, etc.) are appropriate for CM-A assuming that those problems can also be addressed in the treatment.
Behavioral Interventions
An integral part of the CM treatment approach is the use of behavior plans to reinforce positive changes. The therapist, in full collaboration with the youth and parents, create a system where the youth has the ability to earn rewards and access privileges for negative urine screens but also earn age-appropriate consequences for positive screens.
This system helps drive the youth’s motivation to avoid drugs by giving them a positive goal to work toward that is an alternative to seeking drugs. The parent plays an integral part in this stage of treatment by helping set the rules, identifying the rewards and consequences, and monitoring and supervising the youth. By being active participants in the treatment, the parents help create a framework of clear expectations around substance abuse that, over time, help the youth develop their own internal rules, good judgement, and problem-solving skills.
Cognitive-Behavioral Interventions
The cognitive-behavioral interventions used in CM target the social-skill and problem-solving skill deficits that are commonly found in youth with substance abuse problems. Throughout treatment the therapist works closely with the youth and parent(s) to closely examine the specific triggers of the youths drug use.
This is a highly individualized process during which the therapist helps the youth walk through the specific people, places, times, situations, thoughts and feelings that drive the youths drug seeking and drug using behaviors. Through this highly individualized approach the youth learns to recognize triggers and develop strategies to avoid high-risk situations, cope with unavoidable risky situations, use effective drug refusal skills, and utilize alternative coping strategies. The parent is an active participant in this process by helping offer strategies to avoid triggers and supporting the teen’s use of new skills for refusing drugs.
These strategies include:
- Avoiding triggers and situations that can lead to drug use or drug seeking behaviors
- Rearranging the environment to remove triggers and items associated with use
- Making a plan to increase access to positive activities and decrease access to drug-using peers
- Practice skills for navigating high-risk social situations
Contingency Management Treatment Structure
In this training you will learn to effectively implement contingency management in your outpatient practice. The CM protocol includes a series of interventions that can be adapted to fit the individual client’s needs. Factors such as engagement in services, involvement of a social support system, severity of use, and presence of co-occurring disorders are all considered when determining the timing and duration of treatment and frequency of sessions.
Overview of the Initial TrainingThe typical course of treatment is between 14 to 18 weeks and includes these key modules:
Module 1: Determining the Need for Substance Abuse Treatment
Module 2: Introducing CM to the Client and Social Supports
Module 3: Point-and-Level or Fishbowl Reward System
Module 4: ABC Assessment of Drug Use
Module 5: Self-Management Planning and Drug Refusal Skill Training
Module 6: Drug Testing Protocol
Module 7: Planning for Discharge