Abstract

Contingency management is a highly effective treatment for substance use and related disorders. However, few psychiatrists are familiar with this intervention or its application to a range of patient behaviours. This paper describes contingency management and evidence of its efficacy for reducing drug use. It then details areas in which contingency management interventions can be applied in the context of psychiatric treatments more generally, including increasing abstinence in individuals with dual diagnoses, encouraging attendance in mental health treatment settings, enhancing adherence to psychiatric medications, reducing weight, and improving exercise. Greater awareness and use of contingency management in practice may improve outcomes across a range of mental health and related conditions.

Highlights

  • Contingency management interventions are based on principles of basic behavioural analysis

  • Behavioural principles of positive reinforcement are widely applied in everyday settings, as well as clinical settings

  • A vast amount of empirical evidence indicates the efficacy of contingency management for treating substance use disorders

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Summary

Contingency management principles

Contingency management interventions are based on principles of basic behavioural analysis. Behavioural principles of positive reinforcement are widely applied in everyday settings (childrearing, employment, pet training), as well as clinical settings (autism, conduct disorder in adolescents, intellectual disability). These behavioural principles can be applied to treat substance use disorders. The reinforcers are monetary based and consist of vouchers, analogous to a clinic-managed bank account,[2] or a prize draw with prizes ranging from US$1 to 100 in value.[3] Importantly, in effective contingency management interventions, the magnitude of reinforcement provided (voucher amounts or draws for prizes) increases with sustained periods of abstinence.[2,3]

Evidence base
EDITORIAL Petry Contingency management in psychiatry
Barriers to implementation
Applicability to other settings
Findings
Advantages to healthcare providers
Full Text
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