Diagnosis: Substance and Alcohol Use Disorders

2015 EST Status: Strong Research Support (SEE REPORT) Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings

Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources

Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved

Insufficient Evidence: No meta-analytic study could be identified

Insufficient Evidence: Existing meta-analyses are not of sufficient quality

Treatment pending re-evaluation

1998 EST Status: N/A Research Support Strong: Support from two well-designed studies conducted by independent investigators.

Modest: Support from one well-designed study or several adequately designed studies.

Controversial: Conflicting results, or claims regarding mechanisms are unsupported.

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Brief Summary

Contingency management (CM) treatments evolved from basic behavioral research demonstrating that reinforcing behavior increases the probability it will occur in the future. CM is a structured behavioral therapy that involves: (1) frequently monitoring an objectively verifiable target behavior, (2) reinforcing the behavior each time it occurs using tangible reinforcers, and (3) withholding reinforcement when the target behavior is not met. Often, the target behavior is drug abstinence, but other behaviors such as attendance at treatment, medication adherence, and engagement in treatment-related activities, can also be reinforced. Patients earn reinforcement contingent upon submission of drug negative urine samples or treatment attendance. The two most common CM delivery systems are Prize-based (fishbowl) CM and Voucher CM. In Prize-based CM, patients earn draws from a fishbowl with the chance to win prizes ranging from $1 to $100 in value. In Voucher CM, patients earn set dollar amounts in vouchers; earned vouchers are exchangeable for goods and services. In both Prize- and Voucher-CM, reinforcers typically increase with sustained demonstration of the target behavior.

Usually, CM treatments are in effect for 8-24 weeks, and CM is often 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 or single drug class (e.g., stimulants) 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 to allow for immediate results and reinforcement, and if reinforcement magnitude is consistent with evidence-based protocols.

Treatment Resources

Editors: Rory Pfund, PhD; Meredith Ginley, PhD; Cassandra Boness, PhD; Kristyn Zajac, PhD; Carla Rash, PhD; Katie Witkiewitz, PhD

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals / Outlines

Treatment Manuals
Books Available for Purchase Through External Sites

Training Materials and Workshops

Measures, Handouts and Worksheets

Video Descriptions

Clinical Trials

Meta-analyses and Systematic Reviews