Reinforcing operants other than abstinence in drug abuse treatment: An effective alternative for reducing drug use.

Abstract

This study examines the effectiveness of using vouchers to reinforce either the provision of urine samples testing negative for illicit drugs (UA group) or the completion of objective, individually defined, treatment-plan-related tasks (TP group). A third group was assigned to the clinic's standard treatment (STD group). Participants were randomly assigned to groups after a 6-week baseline-stabilization period. Urine specimens were collected thrice weekly throughout the study. In the UA condition, participants earned $5 (U.S. dollars) in vouchers for each drug-free urine submitted. In the TP condition, participants earned up to $15 in vouchers per week for demonstrating completion of treatment plan tasks assigned by their counselors. Contingencies were in effect for 12 weeks, after which all participants received the clinic's standard treatment. Urinalysis results indicate that the TP intervention was significantly more effective in reducing illicit drug use than either the UA or STD interventions. These effects were maintained with a trend toward continuing improvement for the TP groups even after contingencies were discontinued.

Behavioral Therapies for Drug Abuse

“…Iguchi et al (32) expanded voucher-based contingency management to outcomes other than drug-negative urine specimens, demonstrating that reinforcement of tasks outlined in an individualized, verifiable treatment plan was associated with greater reductions in illicit drug use than reinforcement of drug-free urine specimens. Voucher-based contingency management has also been shown to reduce cocaine (33,34) and opioid (35) use in the context of methadone maintenance, thus extending the availability of contingency management procedures to methadone programs where the ability to offer take-home privileges is restricted.…”

Theory-based active ingredients of effective treatments for substance use disorders

“…These considerations led to a new set of CM interventions that provide rewards for completing tasks patients plan jointly with their counselor, such as participating in skills training and getting involved in 12-step self-help groups. This type of intervention reflects aspects of social control and social learning as well as behavior economic theory, including the development of a client-counselor alliance, collaborative identification of goals, and rewards for desirable goal-directed behaviors that may enhance patients' self-efficacy and coping skills rather than just abstinence from drug use (Iguchi et al, 1997).…”

A Perfect Platform: Combining Contingency Management with Medications for Drug Abuse

“…Clearly, medication compliance is a single behavior in the complex repertory of behaviors that foster recovery including use of skills to avoid drug exposure and development of rewarding behaviors that substitute for incentives provided by drug use. Hence, in addition to or as a substitute for providing incentives for pill-taking, clinicians may incentivize other behaviors that may have more enduring impact on substance use such as attendance at substance abuse treatment, completing homework assignments in CBT (113), meeting short-term treatment goals (114), or engaging in rewarding social activities (21). Timing of interventions is a key issue in bringing about the shift from therapist-delivered tangible incentives for narrowly targeted behaviors such as compliance to naturally occurring rewards for a broad range of recovery behaviors.…”