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Articles Related to Types of Treatment for Drug and Alcohol Addiction
Contingency management interventions have been developed to decrease substance use and improve treatment attendance through the judicious application of behavioral principles. Contingency management is based on a robust basic science literature supporting a position that drug use is, in part, a form of operant behavior. The availability of alternative nondrug reinforcers (i.e. vouchers, prizes) should decrease drug use if they are available in sufficient magnitude and according to a schedule that is incompatible with substance use. Contingency management is a powerful technique that has been used effectively to promote abstinence from alcohol, benzodiazepines, cocaine, nicotine, opiates, marijuana, and methamphetamine.
Perhaps what CM needs most is a well-placed champion to break down barriers to reimbursement at the federal level before implementation efforts can be expected to be widespread. Because many drugs are illegal, society considers substance users to engage in illegal behaviors, and the courts and legal systems may mandate or coerce them into treatment. Thus, rather than reinforcing substance abusers for their progress and attempts at remaining abstinent, some clinics utilize confrontation techniques when patients are suspected of “using” or discharge patients when they are not adhering to program rules. While these negative reinforcement techniques may be effective in altering some behaviors, they also result in an unpleasant environment and context for recovery. Many treatment programs routinely use some forms of reinforcement, such as take-home alcohol and violence statistics methadone privileges for patients who maintain long periods of abstinence or pins and leadership status in Alcoholics Anonymous meetings.
- Contingency management is just one approach used in treatment and recovery from alcohol or other drug addictions.
- Furthermore, most studies of the effects of external rewards were conducted in children or college students, not patients with serious physical or mental disorders.
- Reinforcement can be provided for attendance at therapy sessions (Carey and Carey, 1990), for prosocial behaviors within the clinic (Petry et al., 1998) or for compliance with goal-related activities (Bickel et al., 1997; Iguchi et al., 1997; Petry et al., 2000).
- Rats were tested for drug seeking behavior and then exposed to a discrete-choice procedure where they could respond for either food or drug reward (Caprioli et al., 2015).
- The efficacy of contingency management has been demonstrated in community clinic settings in large randomized clinical trials.
Patient Care Network
Again, thecontingency management group were significantly more likely to maintaincontinuous abstinence throughout the 12-week study period than the standardcare group (5.6% v. 0.5%). More efforts should promote understanding of CM and its benefits, as many clinicians do not believe CM improves outcomes (Benishek et al., 2010; Herbeck et al., 2008). In part, this lack of understanding relates to the technical nature of research reports. Providing clear and interpretable information is one essential step, and both brief educational approaches (Benishek et al., 2010) and more extensive in-person training workshops (e.g., Rash, et al., 2013) show promise in changing knowledge and attitudes about CM. Training efforts should directly address concerns about CM, including issues related to motivation to change and its durability. They should emphasize that long-term change is not possible without first achieving abstinence and no psychosocial intervention does as well as CM in promoting abstinence during treatment.
Behavior Analysis, Applied
Contingency management is effective regardless of patients’ background characteristics, pre-existing conditions, or presenting problems. Similarly, CM improves outcomes compared to usual care among patients with issues like criminal justice system involvement, medical comorbidities, previous treatment attempts, unemployment, and homelessness (Petry, Rash, & Easton 2011; Rash, Alessi, & Petry 2008; Schumacher et al., 2007; Silverman, DeFulio, & Sigurdsson 2012; Walter & Petry 2015). We are aware of no studies demonstrating adverse outcomes of CM relative to standard care in any population. The intervention appears to be useful in assisting individuals tolose weight.11Given high comorbidity between overweight/obesity and psychiatric disorders,contingency management for weight loss may be advantageous in psychiatricpatients with obesity. Although more than 30 years of research evidence collected throughout the world supports the effectiveness of CM, widescale implementation of CM in clinical care has been limited, particularly due to funding and regulatory issues.
As with other addiction therapies, contingency management does not treat the underlying cause of the addiction, and in a number of addicts is not effective at all (Carroll and Onken, 2005). Furthermore, CM can be applied in virtually any context or setting and alongside any other form of treatment. Although CM can be integrated alongside virtually any other therapy and almost always demonstrates benefits compared to standard care or other platform therapies, it does not always yield synergistic effects with other treatments (Carroll et al., 2012; Godley et al., 2014). Preclinical procedures modeling choice-based suppression of drug intake are widely thought to emulate the voluntary abstinence commonly observed in clients undertaking contingency management (Caprioli et al., 2015).
Another concern is that CM, with its emphasis on external reinforcement, may impede intrinsic motivation to change. Intrinsic motivation refers to one’s desire to do something because it is self-fulfilling, while extrinsic motivation relates to doing something to obtain an item of value or to bromide detox avoid punishment. Cognitive evaluation theory proposes that external reinforcers, that shift causality from internal factors to those outside the person, reduce feelings of autonomy and competence necessary for behavior change (Deci & Ryan 1985; Ryan & Deci 2000). Accordingly, this theory predicts behavior should return to its initial state once reinforcers are removed (Deci, Koestner, & Ryan 1999). Petry NM, Martin B (in press), Lower cost contingency management for treatment cocaine and opioid abusing methadone patients.
Research is currently underway that is focused on determining schedules and/or durations of reinforcement that maximize the long-term effect of contingency management interventions on drug abstinence. Contingency management (CM) is a behavioral therapy, based on operant conditioning principles, that provides tangible reinforcers for evidence of behavior change. In the case of substance use disorders, it most often involves delivery of monetary-based reinforcers for submission of drug negative urine samples. Research on this intervention dates back over 30 years and consistently shows that CM improves drug signs you were roofied abuse treatment outcomes (Higgins, Silverman, & Heil, 2008; Petry, 2012). Importantly, CM is efficacious for numerous substance use disorders, it can be implemented alongside virtually any platform psychotherapy or pharmacotherapy, and it is efficacious regardless of patients’ characteristics or pre-existing conditions (e.g., Lussier, Heil, Mongeon, Badger, & Higgins 2006; Prendergast, Podus, Finney, Greenwell, & Roll 2006). When it comes to treating individuals with substance use disorders (once commonly referred to as drug abuse or substance abuse disorders), research shows that CM works.
Contingency management provides positive reinforcement in the form of tangible incentives for abstinence (Prendergast et al., 2006) and has been shown to be effective for the treatment of methamphetamine use in sexual minority men when used in isolation (Reback et al., 2010) and when combined with CBT (Shoptaw et al., 2005). Further, it has been shown to enhance substance use disorder treatment (Roll et al., 2006). Contingency management in combination with urine-screening visits, drop-in group support, and referral for other services in a community setting was a feasible and acceptable form of substance use treatment for methamphetamine using men who have sex with men (MSM) (Gómez et al., 2018).