What is Contingency Management and How Does It Help Recovery?

The concept of rewarding positive behavior with some type of tangible reward is often applied in addiction treatment through a type of therapy called contingency management. It’s frequently used to help motivate clients to sustain their sobriety, and in many instances, it increases overall success in recovery.

If you’re unfamiliar with contingency management and how it works in addiction treatment, you’re not alone. Below, we’ll dive into the details and explore some examples and benefits of this type of treatment method.

What is Contingency Management?

Contingency management (CM) is a type of behavioral therapy. It uses incentives and tangible rewards to motivate a person to get sober and maintain their sobriety. It’s based on the principle of operant conditioning, which states that behavior is shaped by its consequences.

The goal of contingency management is to help people maintain consistent and effective behavior even when they are faced with difficult or challenging situations and emotions. In a sense, CM helps clients become empowered by their goals or personal values to sustain their sobriety.

How Does Contingency Management Work?

Contingency management does not have to be implemented by a therapist. Entire programs or systems can use it to help individuals quit alcohol or drugs and stay sober. However, in a rehab setting, contingency management is likely to be used by a counselor or addiction treatment professional.

In a sober living setting, contingency management may be used by program coordinators, certified peer recovery support specialists, sponsors, or house managers to motivate residents to sustain their sobriety.

For contingency management therapy to be effective, it should incorporate the following factors:

• The program should be clear about what is expected of the client. The desired behavior(s), which may be a variety of things, should be clearly defined. Examples might be passing a drug test, attending recovery meetings, or getting a job after completing rehab.
• The program should offer appropriate and desirable rewards. For CM to work, the client must want the reward and be motivated to get it.
• The program should provide realistic rewards and also ones that are appropriate to the individual’s needs. (For example, if a client is likely to misuse a cash voucher, they should be rewarded with something different.)
• The reinforcements should become more valuable over time. Although rewards may begin as monetary prizes, they should shift with time and become things like enhanced privileges, which are more valuable. This approach is useful to reinforce more challenging achievements, like maintaining long-term employment as opposed to just getting the job. (Although both are positive!)
• The reinforcement should occur as quickly as possible after the desired behavior. If there is too much time between the desired behavior and the reward, CM will be less effective.
• The program should allow for sufficient time and duration of treatment. For contingency management to work, sufficient time in treatment is necessary. It will take time for a newly sober individual to establish new habits and start associating sobriety with a positive psychological and physical response.
• The program should produce sober individuals that are internally motivated. The overall goal of contingency management is to teach the brain to recognize ongoing sobriety as a positive thing. Once a person is ready and has a firm relapse prevention plan in place, they should move on from this type of program and won’t seek external rewards for staying sober anymore.

What is an Example of Contingency Management Intervention in Addiction Treatment?

Depending on the treatment environment and the type of recovery program, contingency management may look different. Here are a few examples of what it might look like during an IOP treatment program or a sober living program:

• Rewarding a sober home resident with a curfew extension after a negative toxicology screen.
• Rewarding a residential rehab client with a cash voucher after achieving a treatment goal.
• Rewarding an IOP client with a gift card after attending all scheduled counseling sessions.
• Taking away the privilege of attending off-campus social events hosted by the sober home after a client relapses.

How Effective is Contingency Management?

Several different research studies show strong evidence that contingency management is highly effective in the treatment of substance use disorders.^1,2,3 According to the Recovery Research Institute, several different research studies provide strong evidence that contingency management therapy helps engage individuals in treatment and increases abstinence rates during treatment too.⁴

The organization states, “prize reinforcement contingency management is one of the most effective treatment approaches directly addressing substance use disorder. CM also has strong empirical support as a conjunctive intervention to increase psychosocial treatment and medication adherence.”

Contingency management has also been found to be highly effective in treating individuals with dual diagnoses, who historically have higher rates of substance use disorders.⁵

Despite the evidence of these benefits, contingency management isn’t used as frequently as other types of behavioral therapies in outpatient addiction treatment programs or with recovery support services like sober living. Some addiction recovery programs refuse to use contingency management as a treatment intervention. Critics of contingency management argue that the method of treatment is not philosophically sound and that individuals should not be paid money to abstain from alcohol or drugs. In other cases, treatment providers are not familiar with contingency management or they lack the formal training to use it.

Eudaimonia’s Three Phase Program for Sober Living Residents

At Eudaimonia Recovery Homes, our Three Phase Recovery Program uses a form of contingency management to help clients achieve their sobriety goals and sustain long-lasting recovery. The program is intentionally designed to help our sober living residents adjust to their freedom of choice and responsibility after completing treatment in a rehab program.

Residents work closely with a recovery coach to achieve their program objectives. As they achieve them, they receive rewards, including curfew extensions or overnight passes. The more objectives they achieve, the more rewards they receive, and the more they assimilate into an independent life in recovery.

Our sober living clients work through the Three Phase Program one phase at a time. The tables below include the objectives for each phase as well as the rewards for achieving them.

Phase 1

Objectives	Category	Rewards
Obtain a sponsor	Recovery foundation	Curfew extensions
Living quarters	Life skills	Overnight pass
Employment	Life skills	Curfew time change
Program participation	Recovery foundation

Phase 2

Objectives	Category	Rewards
Service work	Recovery foundation	Curfew extensions
Budgeting	Life skills	Additional overnight passes
Maintain employment	Life skills	Curfew time change
Sponsoring others	Recovery foundation	Drop down in program structure

Phase 3

Objectives	Category	Rewards
Maintain service work	Recovery	Additional weekend passes
Community involvement	Recovery	Drop down in program structure
Maintain employment	Life skills
Program compliance	Recovery foundation

Eudaimonia clients enrolled in our Three Phase Program are also required to attend three different types of weekly meetings:

• A new beginners meeting
• A same-sex meeting
• An alumni meeting

Residents under the age of 25 are also required to attend one additional meeting per week.

What Are the Benefits of Our Three Phase Program for Recovery?

As Eudaimonia residents work through each phase of the program, they learn important life skills that will help them establish and maintain a stable, sober life after rehab. They also learn the value of responsibility as they work to achieve each program objective and develop stronger relationships and bonds with their peers in recovery, their sober coaches, and other mentors in recovery. Our Three Phase Program is also designed to help newly sober individuals adjust to a lifestyle of sobriety and acclimate into a more independent lifestyle. As Eudaimonia residents establish a solid foundation in their recovery, our Three Phase Program will serve as a structured guide.

Enroll Yourself or a Loved One In Our Sober Living Program

If you or a loved one needs help staying sober, Eudaimonia Recovery Homes can help. We use research-based methods like contingency management to provide intensive outpatient treatment, recovery support, and sober living programs for men, women, and LGBTQ+ individuals in recovery.

Please call (512) 363-5914 today to speak with an admissions representative for more information.

References:

1. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/contingency-management-treatments/886133BA4C103AE8DD205B96EB607FB0
2. https://pubmed.ncbi.nlm.nih.gov/15796645/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518350/
4. https://www.recoveryanswers.org/resource/contingency-management/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083448/