Contingency management in addiction research

What is Contingency management?

Contingency management is a treatment strategy that aims to increase motivation and encourage positive behaviours. It’s based on the simple behavioural principle that if a behaviour is rewarded it is more likely to be repeated. In psychology this is known as operant conditioning.  This principle is used in everyday life.

Examples of contingency management in everyday life:

  • Parents use pocket money (incentive) to encourage children to tidy their bedrooms (positive behaviour)
  • Employers use salaries and bonuses (incentive) to reward high performance and hitting targets (positive behaviour)

 

Contingency management as an intervention in addiction treatment

In addiction treatment contingency management can be used to encourage and reward behaviours that are consistent with a drug free lifestyle. Rewards are often in the form of vouchers or gift cards that can be exchanged for goods and services that are also compatible with a drug free way of life.

 

Contingency management as an intervention in addiction treatment

Examples of contingency management in addictions treatment:

  • Service users are rewarded for providing urine specimens that test negative for drugs, encouraging abstinence.
  • Service users are rewarded for attending clinic appointments, encouraging engagement with treatment

 

Contingency management in addiction treatment – is it controversial?

There is a controversy surrounding the use of contingency management in addictions services. One of the main concerns is that the financial incentives given to service users could be used to buy drugs. Another concern is that by encouraging behaviour change with external rewards the participants’ internal motivation could be reduced, which could lead to problems with motivation in the long term. Contingency management has also been criticised because it not only costs a lot with regards to the incentives given but also with regards to the amount of time it takes for it to be administered. However there is scientific evidence to suggest that contingency management is worth the investment.

Contingency management and addictions research – The ADAM trial

Research studies have previously demonstrated that incentive-based treatments are successful in motivating people to remain abstinent from drugs and remain in treatment. These research studies have been carried out with a variety of drugs including stimulants, opioids, marijuana, nicotine and alcohol.

RD CM

One aim of the ADAM Trial is to find out whether contingency management is successful at encouraging participants to engage with the telephone support provided by the pharmacist. Participants who are randomised to receive both the telephone support and the incentive, which is called the personal achievement award, will be rewarded with a £5 Love2Shop voucher for each of the 12 telephone call they complete over the 6 months of the study. In addition to this participants will be rewarded with a bonus each time they complete four calls in a row. A total of £120 can be earned for completing all support sessions and these vouchers can be spent in a range of places including high street stores, supermarkets (excluding cigarettes and alcohol) and on days out.

 

Personal achievement award

Sessions completed Incentive Bonus Running total
1 £5 £5
2 £5 £10
3 £5 £15
4 £5 £10 £30
5 £5 £35
6 £5 £40
7 £5 £45
8 £5 £20 £70
9 £5 £75
10 £5 £80
11 £5 £85
12 £5 £30 £120
Total £60 £60 £120

 

By carrying out this research we are able to learn about how effective the personal achievement award is at increasing engagement with telephone based support for alcohol dependence.

If you are taking part in the ADAM Trial and would like more information about where you can spend your Love2Shop vouchers, please click here https://www.highstreetvouchers.com/gift/where-to-spend-love2shop-cards

References

Cameron, J., & Ritter, A. (2007). Contingency management: perspectives of Australian service providers. Drug Alcohol Review, 26(2), 183-189.

National institute on drug abuse (2012). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine. Retrieved 18 August, 2016, from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-0

Petry, N. M. (2002). Contingency management in addiction treatment. Retrieved 18 August, 2016, from http://www.psychiatrictimes.com/addiction/contingency-management-addiction-treatment-0/page/0/1

Petry, N. M. (2010). Contingency management treatments: Controversies and challenges. Addiction, 105(9), 1507-1509

Petry, N. M. (2000) A comprehensive guide to the application of contingency management procedures in clinical settings. Drug Alcohol Dependence, 58(1-2), 9-25