Contingency Management for Addiction

If you or a loved one are struggling with addiction, you might be wondering about treatment and the types of therapy that might help. Contingency management (CM) can be a beneficial way to address addiction and associated behaviors, which can help you start and stay on the path to recovery.¹

What Is Contingency Management (CM)?

Contingency management (CM) is a treatment approach based on principles of positive reinforcement.¹ Also sometimes called motivational incentives, research has shown that CM is a very effective method for helping people who are working on recovery from addiction.¹ In CM, an incentive is a reward—such as a voucher you can use for food, theater tickets, or other goods—that you can earn for completing treatment-related goals.

In addiction rehab, contingency management therapy might be used as a standalone treatment or combined with other treatment methods and types of therapy, depending on the substance you use.³ Other treatment approaches and recovery supports may include:^2­–4

• Cognitive-behavioral therapy (CBT), which helps you identify and change unhelpful thoughts and behaviors. Research has shown that it can be especially helpful to combine CM and CBT.
• Motivational interviewing (MI), which may help you acknowledge your substance misuse and commit to making positive behavioral changes.
• Medication. Depending on the substance you use, your care team may give you prescription medicines to help reduce cravings, manage withdrawal symptoms, and prevent relapse.
• 12-step programs, which are self-help programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). These groups offer peer support and guidance from others in recovery.

How Does Contingency Management Work?

CM works by offering rewards for meeting desired behavioral targets, such as:^5,7

• Negative drug tests.
• Attending treatment sessions.
• Taking prescribed medicines.

Rewards might include:^5,7

• Access to rehab privileges (for example, computer or phone use, or special appointment times).
• Tangible goods like food.
• Vouchers you can exchange for specific items, such as movie tickets.
• Cash.

Rewards often work better than punishment; this can be because rewards reinforce new behaviors, promote growth, and acknowledge accomplishments, while punishment mainly teaches a person what not to do.⁶

Contingency management strategies are useful for treating substance use disorders (SUDs) because they focus on helping people set both short- and long-term goals and can increase positive behaviors.

Contingency Management Principles

Contingency management plans are developed around 7 core principles:⁷

• The target behavior. A target is an achievable behavior that a person is working on, such as a negative drug test or attending group therapy sessions.
• The target population. This means the specific person or group who are going to get the rewards. People in contingency management addiction treatment programs might be working toward different goals, so they may get different rewards.
• The type of reinforcer, or incentive. This is the specific reward a person will get in exchange for the target behavior. As mentioned above, a reward could refer to vouchers, access to special privileges at the rehab, or coupons for food.
• The magnitude, or amount, of the reinforcer. This means how much of the reward will be offered to a person when they meet the target behavior.
• The frequency of reinforcement distribution. This means how often a person will get the reward when they meet the behavioral goal.
• The timing of reinforcement distribution. That is, when a person gets a reward. Ideally, the reward should offered as close to the target behavior as possible.
• The duration reinforcement(s). This refers to how long a person will get a reward to motivate the target behavior; rewards can have a fixed length (for example, 3 months), or they can vary based on a person’s progress.

Contingency Management Variations

CM can be used in different programs and settings to meet the needs of the target population. The two main types a rehab setting may use are:⁸

• Voucher-based reinforcement (VBR). VBR is mainly used in adults who misuse opioids (such as heroin) or stimulants (such as cocaine). In VBR, people get vouchers every time they have a negative drug screen; these vouchers can be exchanged for tangible goods, such as food, movie passes, or other items. The value of the voucher is low in the beginning, but increases with each consecutive negative drug test; a positive test resets the value to zero.
• Prize incentives. Similar to VBR, this variation of CM awards cash prizes instead of vouchers. The program lasts at least 3 months and people meet at least once per week. Every time someone meets a target behavior, such as negative drug tests, consistent attendance, or completing goal-related activities, they can draw from a bowl to win a cash prize.

Benefits of CM for Addiction

CM offers many possible benefits in the addiction recovery process. These benefits may include:^1,3,5,9,10

• Staying longer in treatment. One study showed that 49% of people who took part in CM completed 12 weeks of treatment as opposed to just 35% of a group whose treatment didn’t include CM.
• Increased attendance. Research shows that people who go through CM attend a greater number of therapy sessions.
• Decreased substance use and possibly longer periods of abstinence. One study showed that people who received CM averaged 4.4 weeks of abstinence (not using substances) from stimulants, as opposed to an average 2.6 weeks for those assigned to standard care. Similar results have been shown with CM for opioids, alcohol, and benzodiazepines.
• Helping people with co-occurring disorders, meaning when substance use disorders and mental health disorders are present at the same time. For example, studies have shown CM to be effective in reducing marijuana and cocaine use in people who have psychotic disorders, as well as reducing alcohol and drug use in people with co-occurring SUDs and serious mental illnesses.
• Effective for treating different types of SUDs. Research has shown that CM is useful for treating addiction to a wide range of substances, including stimulants, opioids, marijuana, nicotine, and polydrug use disorders (using more than one substance at the same time).

How to Find Contingency Management for Substance Use

If you or someone you care about is struggling with addiction or substance misuse, you should know that treatment can help. Therapies such as contingency management can help you start the path to recovery and take back control of your life. Many rehabs, including those owned and operated by American Addiction Centers (AAC), implement CM as well as other evidence-based forms of care in their addiction treatment programs.

AAC has treatment centers across the nation that can help you make a positive change in your life. No matter how things might seem right now, there is always hope. Please call our free, confidential helpline at to speak to a caring admissions navigator about your rehab options and to ask any questions you may have about treatment.