Skip to main content
SpringerLink
Log in

Contingency Management as a Behavioral Approach in Addiction Treatment

  • Chapter
  • First Online:
Textbook of Addiction Treatment

  • 310 Accesses

Abstract

Contingency management is a well-documented intervention for initiating abstinence from abused drugs. The technique is rooted in a long tradition of operant psychology and has copious amounts of foundational and applied research supporting its use. This revised chapter describes the background research, reviews the history of using contingency management, and provides basic information on implementation. This revised chapter includes a new section on technology support for contingency management. The reader will hopefully find this chapter to be a useful basic introduction of the topic.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Ainscough TS, McNeill A, Stang J, Clader R, Brose LS. Contigency management interventions for non-prescribed drug use during treatment for opiate addiction: a systematic review and meta-analysis. Drug Alcohol Depend. 2017;178:318–39.

    Google Scholar 

  2. Alessi SM, Barnett NP, Petry NM. Experiences with SCRAMx alcohol monitoring technology in 100 alcohol treatment outpatients. Drug Alcohol Depend. 2017;178:417–24.

    Google Scholar 

  3. Alessi SM, Petry NM. A randomized study of cellphone technology to reinforce alcohol abstinence in the natural environment. Addiction. 2013;108(5):900–9.

    Google Scholar 

  4. Alessi SM, Roll JM, Reilly MP, Johanson CE. Establishment of a diazepam preference in human volunteers following a differential-conditioning history of placebo versus diazepam choice. Exp Clin Psychopharmacol. 2002;10(2):77–83. https://doi.org/10.1037//1064-1297.10.2.77.

    Article  CAS  Google Scholar 

  5. Amass L, Kamien J. A tale of two cities: financing two voucher programs for substance abusers through community donations. Exp Clin Psychopharmacol. 2004;12(2):147–55.

    Google Scholar 

  6. Amass L, Kamien JB. Funding contingency management in community treatment clinics: use of community donations and clinic rebates. In: Contingency management in substance abuse treatment. New York: Guilford Press; 2008. p. 280–97.

    Google Scholar 

  7. Andrade LF, Petry NM. Contingency management. In: McSweeney FK, Murphy ES, editors. (in press). Wiley-Blackwell handbook of operant and classical conditioning. Oxford: Wiley-Blackwell; 2014.

    Google Scholar 

  8. Aubin H, Luquiens A, Berlin I. Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice. Br J Clin Pharmacol. 2013. https://doi.org/10.1111/bcp.12116.

  9. Barnett NP, Tidey J, Murphy JG, Swift R, Colby SM. Contingency management for alcohol use reduction: a pilot study using a transdermal alcohol sensor. Drug Alcohol Depend. 2011;118(2):391–9.

    Google Scholar 

  10. Bart G. Maintenance medication for opiate addiction: the foundation of recovery. J Addict Dis. 2012;31(3):207–25.

    Google Scholar 

  11. Benishek LA, Kirby KC, Dugosh KL, Padovano A. Beliefs about the empirical support of drug abuse treatment interventions: a survey of outpatient treatment providers. Drug Alcohol Depend. 2010;107(2):202–8.

    Google Scholar 

  12. Boakes RA. From Darwin to behaviourism: psychology and the minds of animals Cambridge [Cambridgeshire]. New York: Cambridge University Press; 1984.

    Google Scholar 

  13. Branson CE, Barbuti AM, Clemmey P, Herman L, Bhutia P. A pilot study of low cost contingency management to increase attendance in an adolescent substance abuse program. Am J Addict. 2012;21(2):126–9.

    Google Scholar 

  14. Carroll ME, Lac ST, Nygaard SL. A concurrently available nondrug reinforcer prevents the acquisition or decreases the maintenance of cocaine-reinforced behavior. Psychopharmacology. 1989;97(1):23–9.

    CAS  Google Scholar 

  15. Dallery J, Raiff BR, Kim SJ, Marsch LA, Stitzer M, Grabinski MJ. Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial. Addiction. 2017;112(5):875–83.

    Google Scholar 

  16. DeFulio A, Silverman K. The use of incentives to reinforce medication adherence. Prev Med. 2012;55:S86–94.

    Google Scholar 

  17. DeFulio A, Stitzer M, Roll J, Petry N, Nuzzo P, Schwartz RP, Stabile P. Criminal justice referral and incentives in outpatient substance abuse treatment. J Subst Abus Treat. 2013;45(1):70–75.

    Google Scholar 

  18. Downey KK, Helmus TC, Schuster CR. Treatment of heroin-dependent poly-drug abusers with contingency management and buprenorphine maintenance. Exp Clin Psychopharmacol. 2000;8(2):176–84.

    CAS  Google Scholar 

  19. Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry. 2008;165(2):179–87. https://doi.org/10.1176/appi.ajp.2007.06111851.

    Article  Google Scholar 

  20. Ferster BF, Skinner CB, Ferster C. Schedules of reinforcement. New York: Appleton-Century-Crofts; 1957.

    Google Scholar 

  21. Flores GP, Peace B, Carnes TC, et al. Performance, reliability, usability, and safety of the id-cap system for ingestion event monitoring in healthy volunteers: a pilot study. Innov Clin Neurosci. 2016;13(9–10):12–9.

    Google Scholar 

  22. Hall EA, Prendergast ML, Roll JM, Warda U. Reinforcing abstinence and treatment participation among offenders in a drug diversion program: are vouchers effective? Crim Justice Behav. 2009;36(9):935–53.

    Google Scholar 

  23. Hartzler B, Lash SJ, Roll JM. Contingency management in substance abuse treatment: a structured review of the evidence for its transportability. Drug Alcohol Depend. 2012;122(1):1–10.

    Google Scholar 

  24. Higgins ST, Bickel WK, Hughes JR. Influence of an alternative Reinforcer on human cocaine self-administration. Life Sci. 1994;55(3):179–87. https://doi.org/10.1016/0024-3205(94)00878-7.

    Article  CAS  Google Scholar 

  25. Higgins ST, Budney AJ, Bickel WK, Foerg FE, Donham R, Badger GJ. Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Arch Gen Psychiatry. 1994;51(7):568–76.

    CAS  Google Scholar 

  26. Higgins ST, Delaney DD, Budney AJ, Bickel WK, Hughes JR, Foerg F, Fenwick JW. A behavioral approach to achieving initial cocaine abstinence. Am J Psychiatry. 1991;148(9):1218–24.

    CAS  Google Scholar 

  27. Higgins ST, Silverman K. Motivating behavior change among illicit-drug abusers: research on contingency management interventions. Washington, DC: American Psychological Association; 1999.

    Google Scholar 

  28. Higgins ST, Silverman K, Heil SH. Contingency management in the treatment of substance use disorders: a science-based treatment innovation. New York: Guilford Press; 2008.

    Google Scholar 

  29. Higgins ST, Washio Y, Heil SH, Solomon LJ, Gaalema DE, Higgins TM, Bernstein IM. Financial incentives for smoking cessation among pregnant and newly postpartum women. Prev Med. 2012;55:S33–40.

    Google Scholar 

  30. Higgins ST, Wong CJ, Badger GJ, Ogden DEH, Dantona DL. Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up. J Consult Clin Psychol. 2000;68(1):64–72. https://doi.org/10.1037//0022-006x.68.1.64.

    Article  CAS  Google Scholar 

  31. Holz WC, Gill CA. Drug injections as negative reinforcers. Pharmacol Rev. 1975;27(3):437–46.

    CAS  Google Scholar 

  32. Hyten C, Madden GJ, Field PD. Exchange delays and impulsive choice in adult humans. J Exp Anal Behav. 1994;62(2):225–33.

    CAS  Google Scholar 

  33. Johnston JM, Pennypacker HS. Strategies and tactics of behavioral research. 2nd ed. Hillsdale: Lawrence Erlbaum Associates, Publishers; 1993.

    Google Scholar 

  34. Kandel DA, Schuster CR. An investigation of nalorphine and perphenazine as negative reinforcers in an escape paradigm. Pharmacol Biochem Behav. 1977;6(1):61–71.

    CAS  Google Scholar 

  35. Kimmel SE, Troxel AB. Novel incentive-based approaches to adherence. Clin Trials. 2012;9(6):689–95.

    Google Scholar 

  36. Kurti AN, Davis D, Redner R, et al. A review of the literature on remote monitoring technology in incentive-based interventions for health-related behavior change. Transl Issues Psychol Sci. 2016;2(2):128.

    Google Scholar 

  37. Ledgerwood DM. Contingency management for smoking cessation: where do we go from here? Curr Drug Abuse Rev. 2008;1(3):340–9.

    Google Scholar 

  38. Ledgerwood DM, Alessi SM, Hanson T, Godley MD, Petry NM. Contingency management for attendance to group substance abuse treatment administered by clinicians in community clinics. J Appl Behav Anal. 2008;41(4):517–26.

    Google Scholar 

  39. Lussier JP, Heil SH, Mongeon JA, Badger GJ, Higgins ST. A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction. 2006;101(2):192–203. https://doi.org/10.1111/j.1360-0443.2006.01311.x.

    Article  Google Scholar 

  40. McDonell MG, Srebnik D, Angelo F, McPherson S, Lowe JM, Sugar A, Short RA, Roll JM, Ries RK. Randomized controlled trial of contingency management for stimulant use in community mental health patients with serious mental illness. Am J Psychiatr. 2013;170(1):94–101.

    Google Scholar 

  41. McSweeney FK, Murphy ESE. Wiley-Blackwell handbook of operant and classical conditioning. Oxford: Wiley-Blackwell; 2014.

    Google Scholar 

  42. Meredith SE, Dallery J. Investigating group contingencies to promote brief abstinence from cigarette smoking. Exp Clin Pschopharmacol. 2013;21(2):144–54. https://doi.org/10.1037/a0031707.

    Article  Google Scholar 

  43. Milby JB, Schumacher JE, McNamara C, Wallace D, McGill T, Stange D, Michael M. Abstinence contingent housing enhances day treatment for homeless cocaine abusers. National Institute on Drug Abuse Research Monograph Series, 174. 1996.

    Google Scholar 

  44. Murphy SM, McDonell MG, McPherson S, Srebnik D, Angelo F, Roll JM, Ries RK. An economic evaluation of a contigency-management intervention for stimulant use among community mental health patients with serious mental illness. Drug Alcohol Depend. 2015;153:293–9.

    Google Scholar 

  45. Nader MA, Woolverton WL. Effects of increasing the magnitude of an alternative reinforcer on drug choice in a discrete-trials choice procedure. Psychopharmacology. 1991;105(2):169–74. https://doi.org/10.1007/Bf02244304.

    Article  CAS  Google Scholar 

  46. Negus SS. Choice between heroin and food in nondependent and heroin-dependent rhesus monkeys: effects of naloxone, buprenorphine, and methadone. J Pharmacol Exp Ther. 2006;317(2):711–23.

    CAS  Google Scholar 

  47. Negus SS, Banks ML. Medications development for opioid abuse. Cold Spring Harb Perspect Med. 2013;3(1).

    Google Scholar 

  48. Oluwoye O, Kriegel L, Alcover K, McPherson S, McDonell M, Roll J. Advances in the dissemination and implementation of contigency management of substance use disorders. Psychol Addict Behav. In Press.

    Google Scholar 

  49. Oluwoye O, Skalisky J, Burduli E, et al. Using a randomized controlled trial to test whether modifications to contingency management improve outcomes for heavy drinkers with serious mental illness. Contemp Clin Trials. 2018;69:92–8.

    Google Scholar 

  50. Packer RR, Howell DN, McPherson S, Roll JM. Investigating reinforcer magnitude and reinforcer delay: a contingency management analog study. Exp Clin Psychopharmacol. 2012;20(4):287–92.

    Google Scholar 

  51. Peirce JM, Petry NM, Stitzer ML, Blaine J, Kellogg S, Kellogg S, Satterfield F, Schwartz M, Krasnansky J, Pencer E, Silva-Vazquez L, Kirby KC, Royer-Malvestuto C, Roll JM, Cohen A, Copersino ML, Kolodner K, Li R. Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Teatment Clinical Trials Network Study. Arch Gen Psychiatry. 2006;63(2):201–8.

    Google Scholar 

  52. Petry N. Contingency management for substance abuse treatment: a guide to implementing this evidence based-practice. New York: Taylor and Francis Group; 2012.

    Google Scholar 

  53. Petry NM. A comprehensive guide to the application of contingency management procedures in clinical settings. Drug Alcohol Depend. 2000;58(1–2):9–25.

    CAS  Google Scholar 

  54. Petry NM, Kolodner KB, Li R, Peirce JM, Roll JM, Stitzer ML, Hamilton JA. Prize-based contingency management does not increase gambling. Drug Alcohol Depend. 2006;83(3):269–73.

    Google Scholar 

  55. Petry NM, Martin B. Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients. J Consult Clin Psychol. 2002;70(2):398–405.

    Google Scholar 

  56. Petry NM, Peirce JM, Stitzer ML, Blaine J, Roll JM, Cohen A, Obert JL, Killeen T, Saladin ME, Cowell M. Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study. Arch Gen Psychiatry. 2005;62(10):1148.

    Google Scholar 

  57. Prendergast M, Hall E, Roll J, Warda U. Use of vouchers to reinforce abstinence and positive behaviors among clients in a drug court treatment program. J Subst Abus Treat. 2008;35(2):125–36.

    Google Scholar 

  58. Prendergast M, Podus D, Finney J, Greenwell L, Roll J. Contingency management for treatment of substance use disorders: a meta-analysis. Addiction. 2006;101(11):1546–60. https://doi.org/10.1111/j.1360-0443.2006.01581.x.

    Article  Google Scholar 

  59. Press Announcements – FDA permits marketing of mobile medical application for substance use disorder. [Website]. 2017. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm576087.htm. Accessed 3 Nov 2017.

  60. Raiff BR, Jarvis BP, Dallery J. Text-message reminders plus incentives increase adherence to antidiabetic medication in adults with type 2 diabetes. J Appl Behav Anal. 2016;49(4):947–53.

    Google Scholar 

  61. Ran R, Mullins ME. Can handling E85 motor fuel cause positive breath alcohol test results? J Anal Toxicol. 2013;37(7):430–2.

    CAS  Google Scholar 

  62. Rash CJ, Andrade LF, Petr NM. Income received during treatment does not affect response to contingency management treatments in cocaine-dependent outpatients. Drug Alcohol Depend. 2013;132(3):528–34.

    Google Scholar 

  63. Rash CJ, DePhilippis D, McKay JR, Drapkin M, Petry NM. Training workshops positively impact beliefs about contingency management in a nationwide dissemination effort. J Subst Abus Treat. 2013;45(3):306–12.

    Google Scholar 

  64. Rash CJ, Petry NM, Kirby KC, Martino S, Roll J, Stitzer ML. Identifying provider beliefs related to contingency management adoption using the contingency management beliefs questionnaire. Drug Alcohol Depend. 2012;121(3):205–12.

    Google Scholar 

  65. Reynolds B, Harris M, Slone SA, et al. A feasibility study of home-based contingency management with adolescent smokers of rural Appalachia. Exp Clin Psychopharmacol. 2015;23(6):486.

    Google Scholar 

  66. Ries RK, Dyck DG, Short R, Srebnik D, Fisher A, Comtois KA. Outcomes of managing disability benefits among patients with substance dependence and severe mental illness. Psychiatr Serv. 2004;55(4):445–7.

    Google Scholar 

  67. Robles E, Silverman K, Preston KL, Cone EJ, Katz E, Bigelow GE, Stitzer ML. The brief abstinence test: voucher-based reinforcement of cocaine abstinence. Drug Alcohol Depend. 2000;58(1–2):205–12.

    CAS  Google Scholar 

  68. Roll JM. Behavioral pharmacology. In: McSweeney FK, Murphy ES, editors. Wiley-Blackwell handbook of operant and classical conditioning. Oxford: Wiley-Blackwell; 2014. p. 612–6.

    Google Scholar 

  69. Roll JM, Chudzynski J, Cameron J, Howell D, McPherson S. Duration effects in contingency management treatment of methamphetamine disorders. Addict Behav. 2013;38(9):2455–62.

    Google Scholar 

  70. Roll JM, Chudzynski JE, Richardson G. Potential sources of reinforcement and punishment in a drug-free treatment clinic: client and staff perceptions. Am J Drug Alcohol Abuse. 2005;31(1):21–33.

    Google Scholar 

  71. Roll JM, Higgins ST. A within-subject comparison of three different schedules of reinforcement of drug abstinence using cigarette smoking as an exemplar. Drug Alcohol Depend. 2000;58(1–2):103–9.

    CAS  Google Scholar 

  72. Roll JM, Higgins ST, Badger GJ. An experimental comparison of three different schedules of reinforcement of drug abstinence using cigarette smoking as an exemplar. J Appl Behav Anal. 1996;29(4):495–504. https://doi.org/10.1901/jaba.1996.29-495.

    Article  CAS  Google Scholar 

  73. Roll JM, Medden GJ, Rawson R, Petry NM. Facilitating the adoption of contingency management for the treatment of substance use disorders. Behav Anal Pract. 2009;2(1):4–13.

    Google Scholar 

  74. Roll JM, Newton T. Contingency management for the treatment of methamphetamine use disorders. In: Higgins ST, Silverman K, Hiel SH, editors. Contingency management in substance abuse treatment. New York: The Guilford Press; 2008. p. 80–99.

    Google Scholar 

  75. Roll JM, Reilly MP, Johanson CE. The influence of exchange delays on cigarette versus money choice: a laboratory analog of voucher-based reinforcement therapy. Exp Clin Psychopharmacol. 2000;8(3):366–70. https://doi.org/10.1037//1064-1297.8.3.366.

    Article  CAS  Google Scholar 

  76. Silverman K, DeFulio A, Sigurdsson SO. Maintenance of reinforcement to address the chronic nature of drug addiction. Prev Med. 2012;55:S46–53.

    Google Scholar 

  77. Silverman K, Robles E, Mudric T, Bigelow GE, Stitzer ML. A randomized trial of long-term reinforcement of cocaine abstinence in methadone-maintained patients who inject drugs. J Consult Clin Psychol. 2004;72(5):839–54.

    Google Scholar 

  78. Silverman K, Roll JM, Higgins ST. Introduction to the special issue on the behavior analysis and treatment of drug addiction. J Appl Behav Anal. 2008;41(4):471–80. https://doi.org/10.1901/jaba.2008.41-471.

    Article  Google Scholar 

  79. Skinner BF. The behavior of organisms: an experimental analysis. Acton: Copley Publishing Group; 1938.

    Google Scholar 

  80. Skinner BF, Heron WT. Effects of caffeine and benzedrine upon conditioning and extinction. Psych Record. 1937;1:339–46.

    Google Scholar 

  81. Smith-Jackson T, Nussbaum M, Mooney A. Accessible cell phone design: development and application of a needs analysis framework. Disabil Rehabil. 2003;25(10):549–60.

    Google Scholar 

  82. Sorensen JL, Haug NA, Delucchi KL, et al. Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial. Drug Alcohol Depend. 2007;88(1):54–63.

    Google Scholar 

  83. Squires DD, Gumbley SJ, Storti SA. Training substance abuse treatment organizations to adopt evidence-based practices: the addiction technology transfer center of new England science to service laboratory. J Subst Abus Treat. 2008;34(3):293–301.

    Google Scholar 

  84. Stitzer ML, Iguchi MY, Felch LJ. Contingent take-home incentive: effects on drug use of methadone maintenance patients. J Consult Clin Psychol. 1992;60(6):927–34.

    CAS  Google Scholar 

  85. Stitzer ML, Petry N, Peirce J, Kirby K, Killeen T, Roll J, Hamilton J, Stabile PQ, Sterling R, Brown C, Kolodner K, Li R. Effectiveness of abstinence-based incentives: interaction with intake stimulant test results. J Consult Clin Psychol. 2007;75(5):805–11.

    Google Scholar 

  86. Thompson T, Schuster CR. Morphine self-administration, food-reinforced, and avoidance behaviors in rhesus monkeys. Psychopharmacology. 1964;5(2):87–94.

    CAS  Google Scholar 

  87. Thompson T, Schuster CR. Behavioral pharmacology. Englewood Cliffs: Prentice Hall, Inc.; 1968.

    Google Scholar 

  88. Tuten M, Jones HE, Schaffer CM, Stitzer ML. Reinforcement-based treatment for substance use disorders: a comprehensive behavioral approach. Am J Addict. 2012;21(5):499–500.

    Google Scholar 

  89. Wong CJ, Sheppard J-M, Dallery J, Bedient G, Robles E, Svikis D, Silverman K. Effects of reinforcer magnitude on data-entry productivity in chronically unemployed drug abusers participating in a therapeutic workplace. Exp Clin Psychopharmacol. 2003;11(1):46–55.

    Google Scholar 

  90. Yoon JH, Higgins ST, Bradstreet MP, Badger GJ, Thomas CS. Changes in the relative reinforcing effects of cigarette smoking as a function of initial abstinence. Psychopharmacology. 2009;205(2):305–18.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Washington State University, Spokane, WA, USA

    John M. Roll, Sterling M. McPherson & Michael G. McDonell

Authors
  1. John M. Roll
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sterling M. McPherson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael G. McDonell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John M. Roll .

Editor information

Editors and Affiliations

  1. Division of Addiction Department of Psychiatry, University of Calgary, Calgary, AB, Canada

    Nady el-Guebaly

  2. Mental Health Department, University of Milano-Bicocca, Monza, Monza e Brianza, Italy

    Giuseppe Carrà

  3. Division of Alcoholism and Drug Abuse Department of Psychiatry, NYU School of Medicine, New York, NY, USA

    Marc Galanter

  4. Population and Behavioural Science Division (Psychiatry and Addictions), University of St Andrews, St.Andrews, UK

    Alexander M. Baldacchino

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Roll, J.M., McPherson, S.M., McDonell, M.G. (2021). Contingency Management as a Behavioral Approach in Addiction Treatment. In: el-Guebaly, N., Carrà, G., Galanter, M., Baldacchino, A.M. (eds) Textbook of Addiction Treatment. Springer, Cham. https://doi.org/10.1007/978-3-030-36391-8_29

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-36391-8_29

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-36390-1

  • Online ISBN: 978-3-030-36391-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation