CONTINGENCY MANAGEMENT
Contingency management therapy involves introducing rewards for therapeutically desired behaviors (e.g., attending therapy sessions, providing substance-negative urine samples) and/or aversive consequences for undesirable behaviors (e.g., failure to adhere to clinic rules0-.
As an adjunctive treatment, contingency management has been used with a variety of substances of abuse, including cocaine, opiates, and marijuana. Incentives to be offered, behaviors to be reinforced, and the reinforcement schedule vary widely by substance and also depend on the role of contingency management within the larger treatment plan. Although most studies have centered on abstinence from substance use, contingency management procedures are potentially applicable to a wide range of target behaviors and problems, including treatment retention, adherence to treatment (e.g., retroviral therapies for individuals with HIV), and reinforcement of other treatment goals such as employment seeking or work attendance. Contingency management is effective when desired behaviors are rewarded with vouchers that can be exchanged for mutually agreed-on items such as movie tickets. Other reinforcers (e.g., free housing, direct compensation) can be substituted for vouchers.
The use of large but low-probability reinforcers (e.g., earning the chance to draw from a bowl and win prizes of varying magnitudes ranging from $1 to more than $100) is also effective and may reduce the total costs of contingency management approaches. Contingency contracting is a subtype of contingency management based on the use of predetermined positive or negative consequences to reward abstinence or punish, and thus deter, drug-related behaviors. Negative consequences of substance use may include notification of Treatment of Patients With Substance Use courts, employers, or family members. The effectiveness of this approach depends heavily on the concurrent use of frequent, random, supervised urine screening for substance use. When negative contingencies are based on the anticipated response of others (e.g., spouses, employers), the treating physician should obtain the patient's written informed consent to contact these individuals at the time the contract is initiated.
Abstinence is one of the most widespread and standard goals of treatment provided by Los Angeles and Orange County intensive outpatient and residential addiction treatment programs. Several treatment program, primarily in the public sector in Los Angeles and Orange County provides contingency management.
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