Contingency management therapy, a path-breaking treatment used for substance use disorders (SUDs), is based on the finding that healthy habits can be developed by rewarding or reinforcing such behaviors. The commonly used reinforcement methods include tangible incentives like vouchers, prizes, free housing and direct payments that assist in developing target behaviors in patients, such as abstinence from drugs.
When patients display target behaviors, such incentives and prizes are awarded to them for motivation. In fact, such a system increases the urge for consecutive performance of target behavior among patients. While the vouchers can be exchanged for services or goods, other incentives like free housing, cash and prizes are directly given to patients.
The key behavioral principles considered while implementing the reward system are regular monitoring, the frequency of occurrence of target behavior, delivery of the reinforced behavior, etc. Some of these behavioral principles are as follows:
Frequency: For an effective contingency management therapy, one needs to ensure the frequent occurrence and regular monitoring of target behavior to reinforce the desired behavior in patients. Therefore, the provision of urine testing must be integrated with the treatment to screen any drug use in them. Such a screening can be conducted on a regular basis. In most of the cases, drug screening can be done twice a week. In the absence of regular screening, most patients fail to recognize the relation between reinforcer (tangible incentives) and target behavior. Therefore, frequent monitoring is required for reinforcing the desired behavior.
Successive approximations: A new behavioral pattern can be established by reinforcing successive approximations in the case of abstinence. In the start, the focus must be on one drug at a time. In order to ensure compliance with activities, simple activities are assigned to the patients during the early stages of contingency management treatment for substance abuse, such as calling for vocational rehabilitation appointment rather attending the appointment. The assignment of easy activities ensures effective completion of the activities by patients.
Priming: Priming is another method that ensures abstinence from substance by providing access to the desired reinforcers to patients, such as a movie ticket of their choice of film or restaurant gift, in the first therapy session. This method motivates patients to receive the desired items by participating in the treatment.
Immediacy: The immediacy of the reinforcer is another important variable of contingency management in addiction treatment. Depending on how soon the rewards are given away to patients, they are ready for learning and altering their behaviors. Such changes occurs best when incentives are given to patients without any delay on displaying the target behavior. Usually, voucher programs provide vouchers immediately on the submission of a negative specimen. A similar pattern must be followed across other programs.
Magnitude: The reinforcer or incentive must be large enough to motivate patients to change their behavior and improve the outcomes. Based on a patient’s learning, the frequency of incentives can be reduced, such as if an individual has maintained the constant abstinence from substances for two to three months. Generally, high-magnitude reinforcers are required to overcome strong effects of drug use. The reinforcer or incentive can be selected according to the individual preference.
Escalating reinforcers and bonuses: When individuals achieve a long period of abstinence, there is an increase in the number of prize drawings and amount of vouchers. This is done to encourage patients to maintain abstinence from substances. When the change in behavior has occurred, the value of the reinforcer can be reduced in magnitude.
Consistency: The implementation of contingency management therapy can become difficult as therapists decrease the frequency of application of contingencies with time. With the decrease in monitoring rate and implementation of less rigorous consequences, there are chances of a relapse or development of drug-seeking behavior in patients. Often, if a patient provides clean urine samples during the first few weeks of treatment, then the frequent testing is turned aside. Later, if the therapist finds the traces of drugs in the patient’s sample, he or she ignores it as an aberration. Therefore, therapists need to ensure patient monitoring on a regular basis.
Road to recovery
These behavioral principles must be considered while designing contingency management therapy. In case something does not work initially, the reinforcement and schedule of monitoring must be re-examined and other options should be considered. The records of the techniques that work or does not work must be maintained in the clinical setups to implement effective measures.
If you or your loved one is suffering from an addiction, contact Sovereign Health of California for an effective contingency management therapy. Our state-of-the-art addiction treatment centers manned by trained medical practitioners provide evidence-based and holistic treatment for addiction. Call our 24/7 helpline number or chat online to access more information.
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