contingency management in drug misuse

Last reviewed 04/2021

Contingency management is a set of techniques that focus on changing specified behaviours (1)

• contingency management (1):
  • in the context of use of contingency management in drug misuse
    • involves offering incentives for positive behaviours such as abstinence or a reduction in illicit drug use, and participation in health-promoting interventions
      • for example, an incentive is offered when a service user submits a biological sample that is negative for the specified drug(s)
      • emphasis on reinforcing positive behaviours is consistent with current knowledge about the underlying neuropsychology of many people who misuse drugs and is more likely to be effective than penalising negative behaviours
  • contingency management aimed at reducing illicit drug use should be considered both during detoxification and for up to 3-6 months after completion of detoxification
  • contingency management during and after detoxification should be based on the following principles
    • the programme should offer incentives (usually vouchers that can be exchanged for goods or services of the service user's choice, or privileges such as take-home methadone doses) contingent on each presentation of a drug-negative test (for example, free from cocaine or non-prescribed opioids)
    • if vouchers are used, they should have monetary values that start in the region of £2 and increase with each additional, continuous period of abstinence
    • the frequency of screening should be set at three tests per week for the first 3 weeks, two tests per week for the next 3 weeks, and one per week thereafter until stability is achieved
    • urinalysis should be the preferred method of testing but oral fluid tests may be considered as an alternative
  • staff delivering contingency management programmes should ensure that:
    • the target is agreed in collaboration with the service user
    • the incentives are provided in a timely and consistent manner
    • the service user fully understands the relationship between the treatment goal and the incentive schedule
    • the incentive is perceived to be reinforcing and supports a healthy/drug-free lifestyle

Reference:

1. . NICE (July 2007). Drug misuse - opioid detoxification.