Prize-Based Contingency Management for Cocaine Dependence

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.

Key References (in reverse chronological order)

  • Petry, N.M., Weinstock, J., Alessi, S.M., Lewis, M.W., & Dieckhaus, K. (2010). Group-based randomized trial of contingencies for health and abstinence in HIV patients. Journal of Consulting and Clinical Psychology, 78, 89-97.
  • Petry, N. M., Alessi, S. M., Ledgerwood, D. M., & Sierra, S. (2010). Psychometric properties of the contingency management competence scale. Drug and Alcohol Dependence, 109, 167-174.
  • Lott, D. C. & Jencius, S. (2009). Effectiveness of very low-cost contingency management in a community adolescent treatment program. Drug and Alcohol Dependence, 102, 162-165.
  • Ghitza, U. E., Epstein, D. H., Schmittner, J., Vahabzadeh, M., Lin, J. L., & Preston, K. L. (2007). Randomized trial of prize-based reinforcement density for simultaneous abstinence from cocaine and heroin. Journal of Consulting and Clinical Psychology, 75, 765-774.
  • Petry, N. M., Alessi, S. M., Hanson, T., & Sierra, S. (2007). Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. Journal of Consulting and Clinical Psychology, 75, 983-991.
  • Peirce, J. M., Petry, N. M., Stitzer, M. L., Blaine, J., Kellogg, S., Satterfield, F., et al. (2006). Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry, 63, 201-208.
  • Petry, N. M., Alessi, S. M., Carroll, K. M., Hanson, T., MacKinnon, S., Rounsaville, B., et al. (2006). Contingency management treatments: Reinforcing abstinence versus adherence with goal-related activities. Journal of Consulting and Clinical Psychology, 74, 592-601.
  • Roll, J. M., Petry, N. M., Stitzer, M. L., Brecht, M. L., Peirce, J. M., McCann, M. J., et al. (2006). Contingency management for the treatment of methamphetamine use disorders. American Journal of Psychiatry, 163, 1993-1999.
  • Petry, N. M., Alessi, S. M., Marx, J., Austin, M., & Tardif, M. (2005). Vouchers versus prizes: Contingency management treatment of substance abusers in community settings. Journal of Consulting and Clinical Psychology, 73, 1005-1014.
  • Petry, N. M., Martin, B., & Simcic, F. (2005). Prize reinforcement contingency management for cocaine dependence: Integration with group therapy in a methadone clinic. Journal of Consulting and Clinical Psychology, 73, 354-359.
  • Petry, N. M., & Martin B. (2002). Low-cost contingency management for treating cocaine and opioid-abusing methadone patients. Journal of Consulting and Clinical Psychology, 70, 398-405.

Clinical Resources

  • Petry, N. M. (2011). Contingency Management for Substance Abuse Treatment: A Guide to Implementing this Evidenced-based Practice. New York: Routledge.

Training Opportunities