Understanding Contingency Management in Substance Use Disorder Treatment
Contingency Management (CM) is a technique that utilizes positive reinforcement to encourage desired behaviors, such as abstinence from stimulants. By offering rewards like vouchers or prizes for achieving goals like submitting stimulant-free urine samples, CM aims to combat the positive and negative reinforcements that contribute to substance use. The practice of CM faces challenges like keeping interventions simple, observable, and easy to track, while also addressing staff resistance and emphasizing intrinsic motivation for patients. Recommendations for implementing CM safely include avoiding advertising incentives, using evidence-based protocols, documenting outcomes, and monitoring effectiveness. Compliance with guidelines for Medicaid/Medicare billable encounters is crucial for successful CM implementation.
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Contingency Management, Part II Stimulants Mini-Deck #14
What is the Theory behind Contingency Management? Substance use is maintained in part through operant conditioning euphoria provides positive reinforcement Alleviation of withdrawal symptoms provides negative reinforcement (increasing a behavior by away something aversive) Thus, we need a reinforcement paradigm powerful enough to combat the positive and negative reinforcement that keeps people who use stimulants coming back for more 2 SOURCE: NIDA, 2010.
What is Contingency Management? A technique employing the systematic delivery of positive reinforcement for desired behaviors. In the treatment of stimulant use disorder, vouchers or prizes can be earned for submission of a stimulant-free urine sample. 3 SOURCE: NIDA, 2010.
CM in Practice: Challenges Must be simple Readily observable Easy to track target behaviors Little burden on the counselor or administrative staff (cannot reward patients and punish staff) 4 SOURCE: NIDA, 2010.
CM in Practice: More Challenges Addressing Staff Resistance Patients should not have to be paid or bribed; recovery is the reward Motivation needs to come from within Reframe CM as an engagement and retention technique along with other traditional behavioral interventions and approaches 5 SOURCE: NIDA, 2010.
CM Recommendations for Safe Harbor Requirements Do not advertise the use of incentives as part of treatment Document need for CM in treatment plan (i.e., client has a moderate or severe stimulant use disorder) Use a research-based CM protocol Carefully document that incentives are linked to client outcomes by carefully documenting each urine drug test result and corresponding incentive that was given for the negative test Regularly evaluate the impact of CM on client outcomes and implement quality improvement procedures to document CM effectiveness Avoid tying CM visits with another Medicaid/Medicare billable encounter Some of these rules may be modified from programs with CMS approval to conduct CM services as a Medicaid/Medicare benefit; any adaptation should be done in careful consideration from state regulatory authority. 6 SOURCE: 42 CFR 1001.952(II)(1)(iii).
