This document provides an overview of contingency management (CM) as an effective treatment approach for substance use disorders. CM is based on operant conditioning principles and aims to encourage positive behavior changes by providing reinforcement, such as vouchers or modest financial incentives, when treatment goals are met. Three key principles of CM are the rate of reinforcement, immediacy of reinforcement, and magnitude of reinforcement. Research studies show CM is effective for reducing substance use and increasing treatment attendance and abstinence both alone and combined with other therapies. However, barriers to wider implementation of CM include a lack of clinician training and negative perceptions of incentivizing behavior change.

1. Contingency Management
in Substance use Disorder
Ms. Mary Infanta P
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2. INTRODUCTION
Conceptual background of CM
Contingency Management : The Theory
What is contingency management
How it’s done…
3principles of contingency Management
How effective it is..
Barriers to implementation
Conclusion
Reference
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ORDER OF PRESENTATION

3. 3
When treating substance use disorders (SUDs) there is a
tremendous need for interventions that motivate individuals to
change their behavior.
Indeed, a waxing and waning commitment to and ambivalence
about change is a common characteristic of SUDs.
Contingency management (CM) is one effective approach to
addressing this need.
INTRODUCTION

4. Conceptual background of CM
• CM-based treatments for SUDs originate in basic behavioral science, namely the
operant-conditioning literature.
• Operant conditioning is a type of learning where the operant (ie, behavior) is
maintained or modified via behavioral consequences.
• CM was born out of the early observation that SUDs largely demonstrate reinforced
operant behavior. Addiction is maintained and reinforced by a combination of
the rewarding biochemical effects of the substance and environmental
influences.
• These behaviors can be modified effectively through altering the behavioral
consequences. 4

5. In such a framework, consequences are classified as
positive reinforcements (ie, delivering tangible
consequences to increase desired behavior)
negative reinforcements (ie, removing an aversive
stimulus to increase desired behavior (e.g., job
suspension)
positive punishments (ie, delivering a punishing
consequence to reduce an undesired behavior(e.g.,
social reprimand)
negative punishments (ie, removing a positive re-
inforcement to reduce an undesired behavior (denial of
clinic privileges)
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6. 6
Contingency Management : The Theory
• Addiction is a complex illness, a large part of which is sustained
through reinforced learning.
• Learning is mediated by the dorsal striatum and becomes hard
wired through procedural learning.
• With procedural learning we cannot unlearn habits; we must learn
new and competing habits.
• The Limbic system connects to the Prefrontal Cortex
CM uses incentivized reinforcement learning to restart the
brain’s Reward system and entrain new behaviors that
drive the process of recovery

7. What is contingency management
• This treatment approach is aimed at encouraging positive behavior by providing
positive reinforcement when patient progresses toward treatment goals
(or)
• by withholding the positive reinforcement or providing punitive measures when
the patient engages in undesirable behavior.
• It refers to a type of behavioral therapy in which individuals are ‘reinforced’, or
rewarded, for evidence of positive behavioral change.
• The positive reinforcement for behavior change often includes vouchers,
privileges, prizes or modest financial incentives that are of value to the patient.
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8. How it’s done…
• In contingency management interventions for substance misuse treatment, urine
samples are collected multiple times each week (to detect brief periods of abstinence)
and abstinence is reinforced each time negative samples are submitted.
• Ex: Abstinence, decreased drug use, treatment attendance, or medication adherence.
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9. How its done…
• (1) a well articulated contract, in writing when possible, to stipulate what behavior
change is expected of the patient, what the consequences will be when the behavior
change does and does not occur, and the start and stop dates of the intervention.
• (2) an operationally defined therapeutic target that allows for independent observer
agreement on the occurrence or nonoccurrence of the target.
• (3) use of an objective means of verifying occurrence of the target behavior whenever
possible.
• (4) a well-specified schedule for monitoring compliance with the contract.
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10. • (5) a schedule that includes frequent opportunities for the patient to interact with
and learn from the reinforcement contingencies.
• (6) a minimal number of behaviors that are simultaneously being targeted for
change.
• (7) short temporal delays between verifying compliance with the therapeutic target
and delivering the programmed consequences.
• (8) a consequence of sufficient magnitude, intensity, or value to function as an
effective reinforcement.
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11. 11
3 principles of contingency Management
The rate of reinforcement - the amount of reinforcement per behavior
Immediacy of the reinforcement being delivered - exchange
delays
The Magnitude or size of the reinforcement.

12. How effective it is..
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TITTLE Authors Result
The Use of
Contingency
Management and
Motivational/Skills-
Building Therapy to
Treat Young Adults
With Marijuana
Dependence
Kathleen M. Carroll,
Caroline J. Easton,
Charla Nich et, al
(2006)
The combination of MET/CBT plus CM was
significantly more effective than MET/CBT
without CM or DC plus CM, which were in turn
more effective than DC without CM for treatment
attendance and percentage of marijuana-free
urine specimens. Participants assigned to
MET/CBT continued to reduce the frequency of
their marijuana use through a 6-month follow-up.
Effectiveness of
contingency
management for
smoking cessation
in substance users:
A systematic review
and meta-analysis
Secades-Villa,
Roberto Aonso-Diego,
Gema García-Pérez,
Ángel González-Roz,
Alba
(2020)
This study informs on the efficacy of contingency
management for facilitating short-term smoking
abstinence and cigarette reductions in substance
users. Delivering contingency management
solely or as an adjunctive smoking cessation
intervention is advisable for a significant impact
on public health. (PsycInfo Database Record)

13. Barriers to implementation
• Despite this range of evidence, implementation of CM in treatment programs is not
widespread and research indicates reluctance by organizational leadership to adopt
it and clinicians are least familiar with.
• Reasons for the lack of use range from little formal training or coursework in behavior
analysis generally or contingency management specifically, ideological concerns,
disconnect between research and practice, and costs.
• Clinicians and the public sometimes hold negative views of this treatment and
express concerns that it does not lead to long-term benefits.
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CONCLUSION
o There has been significant progress and expansion in the development of evidence-
based psychosocial treatments for substance abuse and dependence.
o There is a strong evidence that Contingency Management is an effective strategy in
treatment of substance use disorders, particularly, opioids, tobacco and poly
substance use.
o CM interventions are effective and sufficiently versatile to be used in many different
settings and with many different populations in need of treatment for SUDs.

15. REFERENCES
• Contingency Management: The Greatest Unused Treatment in Opioid Use Disorder-David R. Gastfriend, M.D., DFASAM
Chief Architect, CONTINUUM – The ASAM Criteria Decision Engine, ASAM Chief Medical Officer, DynamiCare Health, Inc.
Senior Research Scientist, Treatment Research Institute of Public Health Management Corp.
• Petry, N. M. (2011). Contingency management: what it is and why psychiatrists should want to use it. The psychiatrist,
35(5), 161-163.
• Aletraris, L., Shelton, J. S., & Roman, P. M. (2015). Counselor attitudes toward contingency management for substance
use disorder: Effectiveness, acceptability, and endorsement of incentives for treatment attendance and abstinence.
Journal of substance abuse treatment, 57, 41-48.
• Lott, D. C., & Jencius, S. (2009). Effectiveness of very low-cost contingency management in a community adolescent
treatment program. Drug and Alcohol Dependence, 102(1-3), 162-165.
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16. Thank you!
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