Contingency management#Voucher programs and related applications in addiction treatment

One form of contingency management is the token economy system.Zlomke, L. (2003). Token Economies. The Behavior Analyst Today, 4 (2), 177–184 [http://www.baojournal.com BAO] Token systems can be used in an individual or group format.{{Cite journal |last=Axelrod |first=Saul |date=1973 |title=Comparison of individual and group contingencies in two special classes |url=http://dx.doi.org/10.1016/s0005-7894(73)80076-0 |journal=Behavior Therapy |volume=4 |issue=1 |pages=83–90 |doi=10.1016/s0005-7894(73)80076-0 |issn=0005-7894|url-access=subscription }} Token systems are successful with a diverse array of populations including those suffering from addiction,Petry, N.M. (2001) Contingent reinforcement for compliance with goal-related activities in HIV-positive substance abusers. The Behavior Analyst Today, 2 (2), 78 [http://www.baojournal.com BAO] those with special needs,{{Cite journal |last1=Birnbrauer |first1=J.S |last2=Wolf |first2=M.M |last3=Kidder |first3=J.D |last4=Tague |first4=Cecilia E |date=1965 |title=Classroom behavior of retarded pupils with token reinforcement |url=http://dx.doi.org/10.1016/0022-0965(65)90045-7 |journal=Journal of Experimental Child Psychology |volume=2 |issue=2 |pages=219–235 |doi=10.1016/0022-0965(65)90045-7 |issn=0022-0965|url-access=subscription }} and those experiencing delinquency.{{Cite journal |last1=Wolf |first1=Montrose M. |last2=Phillips |first2=Elery L. |last3=Fixsen |first3=Dean L. |last4=Braukmann |first4=Curtis J. |last5=Kirigin |first5=Kathryn A. |last6=Willner |first6=Alan G. |last7=Schumaker |first7=Jean |date=1976 |title=Achievement place: The teaching-family model |url=http://dx.doi.org/10.1007/bf01555232 |journal=Child Care Quarterly |volume=5 |issue=2 |pages=92–103 |doi=10.1007/bf01555232 |s2cid=143728487 |issn=0045-6632|url-access=subscription }} However, recent research questions the use of token systems with very young children.Filcheck, H.A., & McNeil, C.B. (2004). The Use of Token Economies in Preschool Classrooms: Practical and Philosophical Concerns. JEIBI, 1 (1), 95–99 [http://www.baojournal.com BAO] The exception to the last would be the treatment of stuttering.Ryan, B.P. (2004) Contingency Management and Stuttering in Children, The Behavior Analyst Today, 5 (2), 144–169 [http://www.baojournal.com BAO] The goal of such systems is to gradually thin out and to help the person begin to access the natural community of reinforcement (the reinforcement typically received in the world for performing the behavior).Baer, D.M., & Wolf, M.M. (1970). "The entry into natural communities of reinforcement". In R. Ulrich, T. Stachnik, & J. Mabry (Eds.), Control of human behavior: Volume II. Glenview, Ill.: Scott, Foresman.

Walker (1990) presents an overview of token systems and combining such procedures with other interventions in the classroom.Walker, H. (1990). The Acting Out Child. Soporis West. He relates the comprehensiveness of token systems to the child's level of difficulty.

Another form of contingency management is voucher programs. In voucher-based contingency management patients earn vouchers exchangeable for retail items contingent upon objectively verified abstinence from recent drug use or compliance with other behavior-change targets. This particular form of contingency management was introduced in the early 1990s as a treatment for cocaine dependence.Higgins, ST, et al., (1991) A behavioral approach to achieving initial cocaine abstinence, Am J of Psychiatry, 148, 1218–1224.Higgins, ST, et al. (1993). Achieving cocaine abstinence with a behavioral approach. Am J of Psychiatry, 150, 763–769 The approach is the most reliably effective method for producing cocaine abstinence in controlled clinical trials.Lussier, JP, et al. (2006). A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction, 101, 192–203.Prendergast ML, Hall EA, Roll J, Warda U. (2007). Use of vouchers to reinforce abstinence and positive behaviors among clients in a drug court treatment program. J. Subst Abuse Treat.

Medication take-home privileges is another form of contingency management frequently used in methadone maintenance treatment. Patients are permitted to "earn" take-home doses of their methadone in exchange for increasing, decreasing, or ceasing certain behaviors. For example, a patient may be given one take-home dose per week after submitting negative drug screens (generally via urine testing) for three months. (Take-home-doses (or "bottles") are seen as desirable {{by whom|date=December 2024}} rewards because they allow patients to come to the clinic less often to obtain their medication).

Based on applied behavior analysis (ABA), contingency management includes techniques such as choice and preference assessments, shaping, making contracts between the therapist and patient, community reinforcement approach and family training, and token economy.

Contingent vouchers are also used to cease smoking addictions. One study claims that people with substance use disorders can receive help with their addiction through the use of voucher-based treatment for smoking. In addition, nicotine replacement (NRT) can help with addiction combined with the vouchers.{{Cite journal|last1=Rohsenow|first1=Damaris J.|last2=Martin|first2=Rosemarie A.|last3=Tidey|first3=Jennifer W.|last4=Colby|first4=Suzanne M.|last5=Monti|first5=Peter M.|title=Treating smokers in substance treatment with contingent vouchers, nicotine replacement and brief advice adapted for sobriety settings|journal=Journal of Substance Abuse Treatment|doi=10.1016/j.jsat.2016.08.012|pmid=27658756|volume=72|pages=72–79|date=January 2017|pmc=5154824}}

A meta-analysis of contingency management in drug programs showed that it has a large effect.{{Cite journal |last1=Schumacher |first1=Joseph E. |last2=Milby |first2=Jesse B. |last3=Wallace |first3=Dennis |last4=Meehan |first4=Dawna-Cricket |last5=Kertesz |first5=Stefan |last6=Vuchinich |first6=Rudy |last7=Dunning |first7=Jonathan |last8=Usdan |first8=Stuart |date=2007 |title=Meta-analysis of day treatment and contingency-management dismantling research: Birmingham Homeless Cocaine Studies (1990-2006). |url=http://doi.apa.org/getdoi.cfm?doi=10.1037/0022-006X.75.5.823 |journal=Journal of Consulting and Clinical Psychology |language=en |volume=75 |issue=5 |pages=823–828 |doi=10.1037/0022-006X.75.5.823 |pmid=17907865 |issn=1939-2117|url-access=subscription }} These contingencies are delivered based on abstinence and attendance goalsStitzer ML, Petry N, Peirce J, Kirby K, Killeen T, Roll J, Hamilton J, Stabile PQ, Sterling R, Brown C, Kolodner K, Li R. (2007). Effectiveness of abstinence-based incentives: interaction with intake stimulant test results. J Consult Clin Psychol., 75 (5), 805–11Petry NM, Alessi SM, Hanson T, Sierra S. (2007). Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. J Consult Clin Psychol., 75 (6), 983–991 and can take the form of vouchers, the opportunity to win prizes or privileges. They have been used with single problem addictions as well as dual diagnosesDrebing CE, Van Ormer EA, Mueller L, Hebert M, Penk WE, Petry NM, Rosenheck R, Rounsaville B. (2007). Adding contingency management intervention to vocational rehabilitation: Outcomes for dually diagnosed veterans. J Rehabil Res Dev., 44 (6): 851–66Ghitza UE, Epstein DH, Preston KL. (Nov. 17, 2007) Contingency management reduces injection-related HIV risk behaviors in heroin and cocaine using outpatients. Addict Behav. and homelessness.Lester KM, Milby JB, Schumacher JE, Vuchinich R, Person S, Clay OJ. (2007). Impact of behavioral contingency management intervention on coping behaviors and PTSD symptom reduction in cocaine-addicted homeless. J Trauma Stress., 20 (4): 565–75. Overall contingency management is an effective and cost-efficient addition to drug treatment.Olmstead TA, Sindelar JL, Petry NM. (2007). Clinic variation in the cost-effectiveness of contingency management. Am J Addict., 16 (6), 457–60

In contrast to these findings in a recent study, the researchers found out that nicotine replacement treatment only improved the effects of contingent vouchers on short-term smoking abstinence. However, in the long term, the effects of contingent vouchers had no impact on tobacco resistance.

Level systems are often employed as a form of contingency management system. Level systems are designed such that once one level is achieved, then the person earns all the privileges for that level and the levels lower than it.Cancio, E. & Johnson, J.W. (2007). Level Systems Revisited: An Impact Tool For Educating Students with Emotional and Behavioral Disorders. International Journal of Behavioral Consultation and Therapy, 3 (4), 512–527. [http://www.baojournal.com BAO]

Many organizations exist for board certified behavior analysts using contingency management programs around the world.

• Applied behavior analysis
• Behaviorism
• Behavior management
• Behavior modification
• Community reinforcement approach and family training
• Contingency contract
• Experimental analysis of behavior
• Operant conditioning
• Professional practice of behavior analysis
• Radical behaviorism
• Reinforcement
• Three-term contingency
• Token economy

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Category:Behavior therapy

Category:Behaviorism

Category:Addiction

Category:Addiction medicine