Contingency management (CM) is the application of the

three-term contingency The three-term contingency (also known as the ABC contingency) is a psychological model describing operant conditioning in three terms consisting of a behavior, its consequence, and the environmental context, as applied in contingency management. ...

(or

operant conditioning Operant conditioning, also called instrumental conditioning, is a learning process in which voluntary behaviors are modified by association with the addition (or removal) of reward or aversive stimuli. The frequency or duration of the behavior ma ...

), which uses

stimulus control In behavioral psychology, stimulus control is a phenomenon in operant conditioning that occurs when an organism behaves in one way in the presence of a given Stimulus (psychology), stimulus and another way in its absence. A stimulus that modifies b ...

and consequences to change behavior. CM originally derived from the science of

applied behavior analysis Applied behavior analysis (ABA), also referred to as behavioral engineering, is a behavior modification system based on the principles of respondent and operant conditioning. ABA is the applied form of behavior analysis; the other two are: ...

(ABA), but it is sometimes implemented from a

cognitive-behavioral therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...

(CBT) framework as well. Incentive-based contingency management is well-established when used as a clinical behavior analysis (CBA) treatment for

substance use disorder Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences to self and others. Related terms include ''substance use problems'' and ''problematic drug or alcohol use''. Along with substance-ind ...

s, which entails that patients earn money (

voucher A voucher is a bond of the redeemable transaction type which is worth a certain money, monetary value and which may be spent only for specific reasons or on specific goods. Examples include house, housing, travel, and food vouchers. The term vou ...

s) or other incentives (i.e., prizes) as a reward to

reinforce In behavioral psychology, reinforcement refers to consequences that increase the likelihood of an organism's future behavior, typically in the presence of a particular '' antecedent stimulus''. For example, a rat can be trained to push a lever ...

drug abstinence (and, less often, punishment if they fail to adhere to program rules and regulations or their treatment plan). Another popular approach based on CM for

alcoholism Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World He ...

is the community reinforcement approach and family training (CRAFT) model, which uses self-management and shaping techniques. By most evaluations, its procedures produce one of the largest effect sizes out of all mental health and educational interventions.

Token economies

One form of contingency management is the

token economy A token economy is a system of contingency management based on the systematic reinforcement of target behavior. The reinforcers are symbols or tokens that can be exchanged for other reinforcers. A token economy is based on the principles of o ...

system. Token systems can be used in an individual or group format. Token systems are successful with a diverse array of populations including those suffering from addiction, those with special needs, and those experiencing delinquency. However, recent research questions the use of token systems with very young children. The exception to the last would be the treatment of stuttering. 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). Walker (1990) presents an overview of token systems and combining such procedures with other interventions in the classroom. He relates the comprehensiveness of token systems to the child's level of difficulty.

Voucher programs and related applications in addiction treatment

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. The approach is the most reliably effective method for producing cocaine abstinence in controlled clinical trials. 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 rewards because they allow patients to come to the clinic less often to obtain their medication). Based on

(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

. 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.

Effectiveness in addiction programs

meta-analysis Meta-analysis is a method of synthesis of quantitative data from multiple independent studies addressing a common research question. An important part of this method involves computing a combined effect size across all of the studies. As such, th ...

of contingency management in drug programs showed that it has a large effect. These contingencies are delivered based on abstinence and attendance goals 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 diagnoses and homelessness. Overall contingency management is an effective and cost-efficient addition to drug treatment. 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

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
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Organizations

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

References