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Practical Application of Contingency Management

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Vouchers for stimulant-free urines. Progressive schedule. Bonuses for 3 ... More immediate effect; shaping: McDonald's coupons, once per week at group, ... – PowerPoint PPT presentation

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Title: Practical Application of Contingency Management


1
Practical Application of Contingency Management
  • Michael J. McCann, MA
  • Matrix Institute on Addictions

2
Elements of Treatment Information, Persuasion,
and Medication
  • Information
  • Matrix Model
  • CBT
  • 12-Step
  • Persuasion
  • Motivational Interviewing
  • Confrontation
  • Contingency Management

3
Motivational Interventions
  • If you build it they will not necessarily come.
  • And, if they do come, they may not come all of
    the time.
  • Hence
  • Motivational Interviewing
  • Contingency Management

4
Contingency Management (CM)
  • CM application of reinforcement contingencies to
    urine results or behaviors (attendance in
    treatment completion of agreed upon activities).
  • Research consistently shows that it works.

5
Contingency Management Overview
  • Research findings
  • Application of CM in the Matrix Institute OTP

6
Research Findings
  • Highlight efficacy
  • Raise questions about real-world applicability

7
Contingency Management Steve Higgins, Ph.D.
  • Community Reinforcement Approach (CRA)
  • Marital Therapy
  • Vocational Assistance
  • Skills Training
  • New social and recreational activities
  • Antabuse
  • Vouchers (977)

8
Contingency Management Higgins et al., 1993
  • 24-week treatment
  • 3 times per week urines
  • Conditions
  • Standard treatment
  • CRA plus vouchers

9
Contingency Management Higgins et al., 1993
10
Contingency Management Higgins et al., 1994
  • How much of CRA effect is CM?
  • 24-week treatment
  • 3 times per week urines
  • Conditions
  • CRA only
  • CRA plus vouchers

11
Contingency Management Higgins et al., 1994
12
Contingency Management Rawson et al., 2002
  • Cocaine-using methadone patients
  • 16 weeks 3 X per week
  • Four conditions
  • CM
  • CBT
  • CBT CM
  • Methadone only

13
Contingency Management Rawson et al., 2002
  • Cognitive-behavioral Treatment (CBT)
  • 90 minute groups
  • Cognitive/behavioral
  • Drug cessation
  • Lifestyle change
  • Relapse prevention

14
Contingency Management Rawson et al., 2002
  • Contingency Management
  • Vouchers for stimulant-free urines
  • Progressive schedule
  • Bonuses for 3 consecutive clean (10)
  • Reset with 5 clean
  • Total earnings possible 1277

15
Cocaine-free Urine Samples During StudyRawson et
al., 2002
Plt.001 CMgtMM CBT CMgtMM
16
Percent Subjects Achieving 3 Consecutive Weeks
Cocaine-freeRawson et al., 2002
Plt.02 CMgtMM CBT CM gtMM
17
Days used cocaine in past month Rawson et al.,
2002
Week 26 CMltMM CBTltMM Week 52 CBTltMM
18
CBT Group AttendanceRawson et al., 2002
Plt.04
19
Contingency Management in Treatment
  • Conclusion CM works

20
CM in Practice
  • What to target?
  • Urine results?
  • Frequent enough? Results immediate?
  • Valid? Observed?
  • Treatment goals
  • Can vary across patient and counselors
  • Verifiable?
  • Attendance

21
CM in Practice
  • Challenges
  • Addressing staff resistance
  • Patients should not have to be paid recovery
    is the reward
  • Motivation needs to come from within

22
CM in Practice
  • Challenges
  • Must be simple
  • Easy to trackNeed to keep a record of attendance
  • Easy to figure rewardsno progressive schedules,
    resets, etc.
  • Little burden on the counselor

23
CM in Practice
  • Challenges
  • Must be inexpensive
  • A less expensive method may be a bit less
    effective, but an expensive method will never be
    used.
  • A little reward goes a long way especially
    combined with praise and recognition

24
CM in Practice in an OTP
  • 5 per month for perfect group attendance
  • 5 per month for perfect medication attendance
  • Easy to track
  • Less expensive than CM in research

25
Perfect medication attendancePre-post
contingencies, n49
Plt.05
26
Perfect group attendancePre-post contingencies,
n49
Plt.01
27
Perfect group attendance in patients missing
pre-CM, n20
28
Groups attended in patients missing pre-CM, n20
Plt.005
29
CM in an OTP Conclusions
  • A simple, low cost CM intervention can improve
    patient attendance in groups and medication
    visits.

30
CM in an OTP Modifications
  • Recent data show diminished effect
  • Perfection too difficult?
  • More immediate effect shaping McDonalds
    coupons, once per week at group, first 30 days of
    treatment

31
CM in an OTP Modifications
  • Raffles
  • Voucher for 1-1 sessions
  • 2 vouchers qualifies for group raffle the
    following month
  • Reinforces attendance in 1-1 and groups
  • Relatively inexpensive
  • No tracking required

32
Conclusions
  • CM can be effectively used in clinical settings
  • Low cost reinforcers can be effective
  • Simple schedules can be effective
  • Increased attendance can offset cost with
    fee-for-service billing
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