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The Contingency Management Approach

A discussion of the contingency management approach in addiction therapy, emphasizing motivation and behavioral reinforcement.

Christopher Lee
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The Contingency Management ApproachThe Contingency Management ApproachThe contingency management approach is a behavioral modification system designed to provide a formal system of rewards (or positivereinforcements) and, sometimes,punishments that make continued drug use and other misbehaviors less attractive than moredesirable alternatives (Griffith, Rowan-Szal, Roark, & Simpson, 2000).For instance, Alcoholics Anonymous (AA) meetings use the chip system that denotes the length of sobriety. Drug courts providepositive incentives on these chips. Therefore, when a client earns recovery time and a positive, prosocial,law-abiding behavior, he orshe is awarded by decreasing his or her treatment from three times a week to two times a week.Principles of the contingency management models emphasize on theimportance of replacing maladaptive behaviors with new healthier behaviors,resulting in behavioral modification.Read the following scenario:John is a thirty-six-year-old divorcee residing with a roommate at hispresent in-patient residential stay. John has a long history of alcohol andcocaine use, starting from the age of nineteen years. Although he hadpreviously attempted to complete the treatment several times, he alwaysleft it prematurely and against medical advice.Consider you are an addiction counselor. After completing detoxification,John has been transferred to your program for thirty days. During the initialconversation with you, he presents a willingness to stay clean and sober.However, later during the program, he exhibits some denial and resistanceto the program rules and the requirements of attending the AA and NarcoticAnonymous (NA) programs.John presents the following risk factors for relapse:•Has no current sober living environment (as he previously stayed with a known addict)•Has lost his job due to a recent driving under the influence conviction•Has limited exposure to sober supports and leisure activities•Had relapsed in the past due to triggers such as stress, limited support, and refusal tofollow through with outpatient treatment and AA or NA meetingsIn this scenario, the contingency management (cm) approach can be effectively employed toaddress john’s addiction and relapse risks. Contingency management is particularly suitable here

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Psychology

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