Contingency management

• Can be used in the treatment of addiction

-              It uses the principles of positive reinforcement, to reinforce a target behaviour such as abstinence from a drug.

-              It uses the three-term contingency ‘ABC’ and is recommend by NICE. It provides reinforcers as a reward for abstinence  (in addiction intervention). It has been empirically validated intervention and is effective in treating substance abuse.

-              In order for it to be effective contingency management, it requires three main conditions:

1.        Frequent monitoring of the target behaviour

2.        Timely presentation of positive reinforcers when target behaviour occurs

3.        No reinforcement when the target behaviour does not occur

-              An example would be attending a rehab / clinic, providing a urine test which comes back negative for drugs and being rewarded with a voucher.

-              There are different types of incentive which can be given but these are not normally money but include stuff such as:

o   Vouchers

o   Credits or points

o   Prize draws

-              Different target behaviours can induced:

o   Abstinence, from stuff such as drugs or smoking during pregnancy

o   Attendance, for unwanted appointments such as treatments or injections

o   Medication adherence

o   Exercise adherence

o   Personal goals within treatment (anything that can be evidenced).

Token economies

-              These can be used as part of contingency management programmes, each time a desirable behaviour is observed a token is given immediately as a reinforcer. This token can be accumulated and later used in exchange or backup reinforcers.

-              Conditioned reinforcers, strengthen desirable behaviours & decrease undesirable behaviours.

Evidence

-              Was found to be highly effective for drug abstinence by Nancy Petry when participants received monetary reinforcement for submitted negative urine samples/ breathalyser.

-              Dutra’s meta-analysis found contingency management to have the strongest effect on drug use.

-              Pfund and Ginley also found it to be effective at improving attendance and having a sustained effect

-              It has also been found to be a virtual part of the treatment for patients receiving medication for opioid use disorders. Shown to be effective for abstinence, treatment adherence, medication adherence and therapy attendance.

-              Used to treat smoking cessation in pregnancy, which is preventable cause of poor pregnancy out comes such as increased infant morbidity and morality rates. Tends to focus on information counselling and feedback on carbon monoxide levels. Rates lower more then 20% lower in the treated groups.

-              Has also been used to increase certain behaviours such as exercise behaviour.

Evaluation of contingency management

-              Practitioners main concerns have included: affordability, potential jealousy between clients and people being drawn into treatment for the wrong reasons. With lesser concerns including: it being labour intensive, negatively impacting motivation, no long lasting effects and it clashing with personal philosophy.

-              The vouchers or incentives to fund drug use

-              Interference with internal motivation

-              Has better retention

-              Has high rates of abstinence

-              Smoking cessation

-              However is expensive