What, Exactly, is Contingency Management?

Addiction, my friends, is a huge problem in the U.S. and around the world. People can be addicted to everything from food to drugs, and the impact of these addictions ruins lives and even entire families.

If you’re struggling with addiction or care for someone who is, you know recovery is often a tough road. There are a lot of different types of programs out there for treating addiction, and today, I’m going to talk about one you may never have heard of: contingency management.

What is contingency management?

Under a contingency management program, a person with addiction earns some sort of reward for staying abstinent. One common format involves the use of coupons or vouchers. Every time the addicted person hits another sobriety milestone, they get to pick from a container of vouchers, where they may earn money or receive an inspirational message.

Although there’s not a lot of research into this type of program yet, there have been some studies. One review of 50 clinical trials published in the PLOS medical journal (https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002715&type=printable) found that for people addicted to cocaine or methamphetamine, the combination of community reinforcement and contingency management was an effective frontline treatment.

The jury is still out

Of course, there have been moral concerns and other objections to contingency management in the professional treatment community. The concept of rewarding a person for abstaining from using something they are addicted to is why publicly funded programs, including Medicaid, do not cover this type of treatment.

Other treatment providers are concerned about giving a person a prize they may trade or sell for the substance they are addicted to. Professionals with this view are concerned that the person may not be at the right point in their lives to go ahead and make any good decisions about money they may receive as a prize in this type of program.

Currently, this type of program isn’t offered many places. Since the federal government views it as a possible violation of federal anti-kickback laws, even private insurance companies will not cover its cost. However, a group of treatment experts are now trying to get the government to recognize contingency management, with no success so far.

It’s too early to tell whether contingency management could help people who are struggling with addiction and not able to recover using more widely-available programs. As the understanding of these types of programs increases, it will become clearer whether this is a viable recovery option or an ineffective one.