Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)
Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine)

Research has demonstrated the effectiveness of treatment approaches using contingency management (CM) principles, which involve giving patients tangible rewards to reinforce positive behaviors such as abstinence. Studies conducted in both methadone programs and psychosocial counseling treatment programs demonstrate that incentive-based interventions are highly effective in increasing treatment retention and promoting abstinence from drugs.

Voucher-Based Reinforcement  (VBR) augments other community-based treatments for adults who primarily abuse opioids (especially heroin) or stimulants (especially cocaine) or both. In VBR, the patient receives a voucher for every drug-free urine sample provided. The voucher has monetary value that can be exchanged for food items, movie passes, or other goods or services that are consistent with a drug-free lifestyle. The voucher values are low at first, but increase as the number of consecutive drug-free urine samples increases; positive urine samples reset the value of the vouchers to the initial low value. VBR has been shown to be effective in promoting abstinence from opioids and cocaine in patients undergoing methadone detoxification.

Prize Incentives CM applies similar principles as VBR but uses chances to win cash prizes instead of vouchers. Over the course of the program (at least 3 months, one or more times weekly), participants supplying drug-negative urine or breath tests draw from a bowl for the chance to win a prize worth between $1 and $100. Participants may also receive draws for attending counseling sessions and completing weekly goal-related activities. The number of draws starts at one and increases with consecutive negative drug tests and/or counseling sessions attended but resets to one with any drug-positive sample or unexcused absence. The practitioner community has raised concerns that this intervention could promote gambling—as it contains an element of chance—and that pathological gambling and substance use disorders can be comorbid. However, studies examining this concern found that Prize Incentives CM did not promote gambling behavior.

Further Reading:

Budney, A.J.; Moore, B.A.; Rocha, H.L.; and Higgins, S.T. Clinical trial of abstinence-based vouchers and cognitivebehavioral therapy for cannabis dependence. Journal of Consulting and Clinical Psychology  74(2):307–316, 2006.

Budney, A.J.; Roffman, R.; Stephens, R.S.; and Walker, D. Marijuana dependence and its treatment. Addiction Science & Clinical Practice  4(1):4–16, 2007.

Elkashef, A.; Vocci, F.; Huestis, M.; Haney, M.; Budney, A.; Gruber, A.; and el-Guebaly, N. Marijuana neurobiology and treatment. Substance Abuse  29(3):17–29, 2008.

Peirce, J.M.; Petry, N.M.; Stitzer, M.L.; Blaine, J.; Kellogg, S.; Satterfield, F.; Schwartz, M.; Krasnansky, J.; Pencer, E.; Silva-Vazquez, L.; Kirby, K.C.; Royer-Malvestuto, C.; Cohen, A.; Copersino, M.L.; Kolodner, K.; and Li, R. 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(2):201–208, 2006.

Petry, N.M.; Peirce, J.M.; Stitzer, M.L.; Blaine, J.; Roll, J.M.; Cohen, A.; Obert, J.; Killeen, T.; Saladin, M.E.; Cowell, M.; Kirby, K.C.; Sterling, R.; Royer-Malvestuto, C.; Hamilton, J.; Booth, R.E.; Macdonald, M.; Liebert, M.; Rader, L.; Burns, R; DiMaria, J.; Copersino, M.; Stabile, P.Q.; Kolodner, K.; and Li, R. Effect of prizebased incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry  62(10):1148–1156, 2005.

Petry, N.M.; Kolodner, K.B.; Li, R.; Peirce, J.M.; Roll, J.M.; Stitzer, M.L.; and Hamilton, J.A. Prize-based contingency management does not increase gambling. Drug and Alcohol Dependence  83(3):269–273, 2006.

Prendergast, M.; Podus, D.; Finney, J.; Greenwell, L.; and Roll, J. Contingency management for treatment of substance use disorders: A meta-analysis. Addiction 101(11):1546–1560, 2006.

Roll, J.M.; Petry, N.M.; Stitzer, M.L.; Brecht, M.L.; Peirce, J.M.; McCann, M.J.; Blaine, J.; MacDonald, M.; DiMaria, J.; Lucero, L.; and Kellogg, S. Contingency management for the treatment of methamphetamine use disorders. The  American Journal of Psychiatry 163(11):1993–1999, 2006.