Prize-Based Contingency Management for Alcohol Use Disorders

Status: Modest Research Support


Contingency management (CM) treatments evolved from basic behavioral research demonstrating that a behavior that is reinforced will increase in frequency. CM is a structured behavioral therapy that involves: (1) frequently monitoring the behavior targeted for change, and (2) reinforcing the behavior each time it occurs using tangible and escalating reinforcers. Often, the behavior targeted for change is drug use behavior, but other behaviors such as attendance at treatment, can also be reinforced. Patients are reinforced for submission of drug negative urine samples or attendance at treatment by earning the chance to win prizes ranging from $1 to $100 in value, and chances to win prizes increase with sustained abstinence or attendance.

Usually, CM treatments are in effect for 8-24 weeks, and CM is typically provided as an adjunct to other treatment. It can be integrated with virtually any form of therapy, including eclectic/standard group treatment, 12-step therapy, cognitive-behavioral therapy, community reinforcement approach therapy, motivational enhancement therapy, and others.

If abstinence is reinforced, the best outcomes of CM are generally achieved if abstinence from a single drug is reinforced (as opposed to requiring abstinence from multiple substances concurrently to receive reinforcement), if urine testing monitoring is conducted at least twice weekly, if onsite (as opposed to offsite) testing procedures are used, and if reinforcement magnitude is high. The prize CM system was designed to enhance patient outcomes while minimizing reinforcement and administrative costs.

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