41 - Community Reinforcement Approach and Contingency Management Therapies

Abstract

The community reinforcement approach and contingency management are behavioral treatments for addictions grounded in principles of reinforcement. The community reinforcement approach is based on the theory that individuals with substance use disorders lack alternative sources of reinforcement to compete with those offered by drugs and alcohol. The goal of the community reinforcement approach is to change environmental contingencies to promote a lifestyle that is more reinforcing than substance use. Contingency management provides tangible reinforcement for positive behavior change, including abstinence from drugs and alcohol, and is usually added to another treatment intervention in order to enhance its efficacy. Tangible reinforcements employed in contingency management interventions include vouchers exchangeable for retail goods and services and opportunities to win prizes. Both the community reinforcement approach and contingency management are highly effective in reducing substance use but adoption in clinical practice has been slow—the community reinforcement approach because it is labor intensive and contingency management because it is perceived to be costly. Less labor-intensive methods of implementing the community reinforcement approach that incorporate contingency management are being developed. The prize-based contingency management approach can be a less-expensive alternative to voucher-based contingency management, and research suggests it has comparable efficacy. Preliminary cost-effectiveness studies suggest that the benefits of contingency management outweigh its costs.