Contingency Management
Encyclopedia
Contingency management is a type of treatment used in the mental health or substance abuse fields. Patients are rewarded (or, less often, punished) for their behavior; generally, adherence to or failure to adhere to program rules and regulations or their treatment plan. As an approach to treatment, contingency management emerged from the behavior therapy and applied behavior analysis
traditions in mental health. By most evaluations, contingency management procedures produce one of the largest effect sizes out of all mental health and educational interventions.
system. Token systems can be used in an individual or group format. Token systems have been shown to be successful with a diverse array of populations including those suffering from addiction, those with retardation, and delinquents. 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 excellent 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.
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. (It is worth noting that 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).
In behavior therapy, behavior modification
, and applied behavior analysis
, contingency management includes techniques such as shaping, time-out
, making contracts between therapist and patient, and token economy
.
Often in a behavior modification facility
, it is common to use point or level systems to maintain order.
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 homeless. Overall contingency management has been found to be an effective and cost efficient addition to drug treatment.
Applied Behavior Analysis
Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment...
traditions in mental health. By most evaluations, contingency management 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 economyToken economy
A token economy is a system of behavior modification based on the systematic positive reinforcement of target behavior. The reinforcers are symbols or tokens that can be exchanged for other reinforcers. Token economy is based on the principles of operant conditioning and can be situated within...
system. Token systems can be used in an individual or group format. Token systems have been shown to be successful with a diverse array of populations including those suffering from addiction, those with retardation, and delinquents. 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 excellent 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
Methadone maintenance
Methadone maintenance is the use of methadone over a prolonged time as treatment for someone who is addicted to opioids or has severe pain problems that are resistant to other drugs.-Modality:...
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. (It is worth noting that 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).
In behavior therapy, behavior modification
Behavior modification
Behavior modification is the use of empirically demonstrated behavior change techniques to increase or decrease the frequency of behaviors, such as altering an individual's behaviors and reactions to stimuli through positive and negative reinforcement of adaptive behavior and/or the reduction of...
, and applied behavior analysis
Applied Behavior Analysis
Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment...
, contingency management includes techniques such as shaping, time-out
Child time-out
A time-out involves temporarily separating a child from an environment where inappropriate behavior has occurred, and is intended to give an over-excited child time to calm down and thereby discouraging such behavior. It is an educational and parenting technique recommended by some pediatricians...
, making contracts between therapist and patient, and token economy
Token economy
A token economy is a system of behavior modification based on the systematic positive reinforcement of target behavior. The reinforcers are symbols or tokens that can be exchanged for other reinforcers. Token economy is based on the principles of operant conditioning and can be situated within...
.
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.Often in a behavior modification facility
Behavior modification facility
A behavior modification facility is a residential educational and treatment institution enrolling adolescents who are perceived as displaying antisocial behavior, in an attempt to alter their conduct. As of 2008 there were about 650 nongovernmental, residential programs in the United States...
, it is common to use point or level systems to maintain order.
Effectiveness in addiction programs
A recent meta-analysisMeta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...
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 homeless. Overall contingency management has been found to be an effective and cost efficient addition to drug treatment.
Organizations
Contingency management is a behavior therapy technique. Many organizations exist for behavior therapists around the world. The World Assocaition for Behavior Analysis offers a certification in behavior therapy http://www.baojournal.com/WCBA/WCBA.html. This certification allows for the demonstration of knowledge regarding contingency management.See also
- Professional practice of behavior analysisProfessional practice of behavior analysisThe professional practice of behavior analysis is one domain of behavior analysis: others being behaviorism, experimental analysis of behavior and applied behavior analysis...
- Token economyToken economyA token economy is a system of behavior modification based on the systematic positive reinforcement of target behavior. The reinforcers are symbols or tokens that can be exchanged for other reinforcers. Token economy is based on the principles of operant conditioning and can be situated within...
- behavior managementBehavior managementBehavior management is similar to behavior modification. It is a less intensive version of behavior therapy. In behavior modification the focus is on changing behavior, while in behavior management the focus is on maintaining order. Behavior management skills are of particular importance to...
- applied behavior analysisApplied Behavior AnalysisApplied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment...