Contingency Management For Addiction Treatment

Medically Reviewed by Johnelle Smith, M.D. on May 27, 2022

Contingency management is an evidence-based treatment for addiction to certain drugs. Due to its incentive structure, it is controversial, but can be highly effective for promoting abstinence from addictive substances.

Contingency Management For Addiction Treatment

Drug addiction is commonly treated with a variety of medical and behavioral health treatments to address all sides of substance abuse on health and overall wellbeing.

One of the top behavioral therapies for increasing abstinence is contingency management. This is an evidence-based treatment commonly used for stimulant addiction.

Here you’ll find information on:

  • what contingency management is
  • how contingency management works
  • benefits of contingency management therapy
  • how to find a contingency management treatment program

What Is Contingency Management?

Contingency management is an evidence-based treatment based on operant conditioning principles that offers incentives (often monetary awards) for achieving certain treatment goals.

Like other behavioral therapies for addiction, contingency management focuses on promoting positive behaviors to support a healthy life in addiction recovery.

Contingency management may be used to treat:

  • cocaine dependence
  • methamphetamine addiction
  • heroin addiction
  • opioid addiction
  • alcohol addiction
  • amphetamine addiction
  • nicotine dependence
  • marijuana abuse
  • dual diagnosis

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How Contingency Management Works

Contingency management is a behavioral treatment that operates under the principle that rewarding people for positive behavior can help incentivize the continuation of that behavior.

With drug addiction specifically, research shows this substance abuse treatment can help promote abstinence from drug use, or the achievement of other milestones in early recovery.

The U.S. National Institute on Drug Abuse (NIDA) writes that there are two primary forms of contingency management treatment for drug addiction:

Voucher-Based Reinforcement

Some contingency management programs offer certain vouchers with cash value for achieving predetermined treatment goals.

For instance, vouchers for food, movie passes, clothing items, or other goods and services capable of supporting a healthy, drug-free lifestyle.

Vouchers are typically offered upon the completion of a breathalyzer or drug test, and may increase in cash value over time with continued abstinence or progress in treatment.

Prize Incentives

CM interventions may also offer prize incentives for a clear urine sample, as a form of positive reinforcement for recovery-focused behavioral change.

Prize incentive programs are similar to voucher-based programs. However, instead of offering vouchers, they offer participants to draw from a bowl for the chance to win a prize valued at anywhere from $1 to $100, on average.

Each time you pass a drug or alcohol test, you receive additional prize draws, which gives you the chance to win more prizes, thus reinforcing continued abstinence.

This type of program has been offered for years through the U.S. Department of Veteran Affairs (VA), for instance, with largely successful outcomes for participants.

Does Contingency Management Work?

Clinical trials show that offering rewards for positive behavior can be effective for promoting cocaine abstinence and abstinence from other addictive substances, like opioids.

This treatment can also:

  • increase treatment retention (i.e. completing a full treatment program for the clinician-recommended length of time)
  • help people overcome apathy or ambivalence about recovery
  • promote other recovery-focused behaviors (i.e. attending counseling sessions, completing community service hours)
  • be cost-effective for communities, when considering societal costs of illicit drug addiction, such as incarceration.

Contingency management is a behavioral approach typically offered alongside other conventional treatments, like counseling, group therapy, and medication-assisted treatment.

This well-rounded approach can help address the many effects of addiction on a person’s physical health, mental health, relationships, and overall well-being.

Where Can I Find Contingency Management?

Contingency management (CM) interventions are offered by some inpatient rehab centers and community-based treatment programs for addiction.

For instance:

  • traditional outpatient programs
  • partial hospitalization programs
  • intensive outpatient programs (IOP)
  • methadone maintenance treatment programs (i.e. MAT)
  • sober living programs

The availability of contingency management at detoxification facilities or addiction treatment centers may vary according to treatment philosophies, where you live, and other factors.

Does Insurance Pay For Contingency Management?

Health insurance coverage for behavioral interventions like contingency management can vary depending on a range of factors.

Factors that can influence insurance coverage include:

  • insurance provider
  • your insurance policy
  • type of treatment program
  • treatment setting
  • deductible requirements
  • in- and out-of-network costs

In addition, unlike other top therapies, such as cognitive behavioral therapy (CBT), CM does not have a billing code for treatment providers.

Some behavioral health providers who treat addiction to cocaine use and other substances say this can be a barrier to providing and expanding this effective addiction treatment.

Contingency Management FAQs

Find answers to frequently asked questions about contingency management therapy for drug and alcohol use disorders.

The length of contingency management programs typically ranges from one to six months on average, according to the U.S. National Institute on Drug Abuse.

Contingency management programs are legal in the United States, provided they do not violate state or federal laws for monetary limits on incentives during rehab.

CM has shown to be effective for treating drug addiction. Any associated drawbacks are largely related to limitations, such as monetary limits required by law and lack of healthcare coverage for this treatment.

Federal law limits the monetary value CM programs funded by federal or state dollars can provide to participants to $75 annually.

Some separate state laws have additional stipulations on monetary incentives offered by rehab providers.

Cognitive behavioral therapy (CBT) and contingency management are two separate, but complementary, forms of behavioral therapy.

They are sometimes offered together as part of a full drug treatment program, alongside other medical or behavioral health treatment services.

Find A Contingency Management Program Today

Hundreds of thousands of people in the United States get help for substance abuse and addiction each year. Let us help you find a rehab program that’s right for you.

Call us today to learn more about contingency management or to find a contingency management program that’s right for you or a loved one with an addiction.

This page does not provide medical advice. See more

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Medically Reviewed by
Johnelle Smith, M.D. on May 27, 2022
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