Contingency management treatments

The British Journal of Psychiatry (Impact Factor: 7.99). 09/2006; 189(2):97-8. DOI: 10.1192/bjp.bp.106.022293
Source: PubMed


Contingency management is highly efficacious in improving outcomes in substance misuse. Whereas a great deal of research has evaluated these interventions empirically, few treatment providers integrate this approach in practice. The rationale for contingency management is described, with a call for expansion of this technique outside the USA.

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    • "A number of effective behavioral treatments have been developed for addictive behaviors (Carroll and Onken, 2005; Dutra et al., 2008; Miller and Wilbourne, 2002). Among those with the strongest level of empirical support from randomized clinical trials are contingency management (CM, where abstinence or other targeted outcomes are reinforced with incentives)(Higgins et al., 1991; Petry, 2006), motivational interviewing (MI, where a specific, nonjudgmental interviewing style is used to enhance motivation and harness the individuals capacity for change)(Hettema et al., 2005; Miller, 1985), and cognitive behavioral therapy (CBT, which teaches specific strategies and skills to reduce substance use) (Carroll et al., 1994; Marlatt and George, 1984). In contrast to the specificity of effects of most medications for drugs of abuse (e.g., methadone or buprenorphine have demonstrated efficacy for opioid dependence with little effect on concomitant cocaine use), empirically validated behavioral therapies tend to be effective across the range of substance use disorders. "
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    ABSTRACT: Drug addiction continues to be an important public health problem, with an estimated 22.6 million current illicit drug users in the United States alone. For many addictions, including cocaine, methamphetamine, and marijuana addiction, there are no approved pharmacological treatments. Behavioral treatments are effective but effects vary widely across individuals. Treatments that are effective across multiple addictions are greatly needed, and accumulating evidence suggests that one such approach may be pharmacological or behavioral interventions that enhance executive inhibitory control in addicts. Current evidence indicates that most forms of chronic drug use may be associated with significant cognitive impairments, especially in attention, working memory, and response inhibition functions. In some studies, these impairments predict poor treatment retention and outcome. A number of cognitive enhancing agents, including galantamine, modafinil, atomoxetine, methylphenidate, and guanfacine, have shown promising findings in human studies. Specific behavioral interventions, including cognitive remediation, also show promise. However, whether improvement of selective cognitive functions reduces drug use behavior remains to be determined. Cognitive enhancement to improve treatment outcomes is a novel strategy worthy of future research, as are related questions such as whether these approaches may be broadly beneficial to most addicts or best reserved for substance users with specific demonstrated cognitive impairments. This article is part of a Special Issue entitled 'Cognitive Enhancers'.
    Neuropharmacology 06/2012; 64(1):452-63. DOI:10.1016/j.neuropharm.2012.06.021 · 5.11 Impact Factor
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    • "This study suggests that it is a key concern for professionals that any single intervention is coherent with the broader goals of the service. In addition to this, these results add empirical data to suggestions from other authors (Petry, 2006; Pilling et al., 2007) that the wider societal and political values that practitioners and service users hold as citizens will have an impact on how new interventions are delivered and received within the healthcare system. Government policy and media coverage will also affect and be affected by societal trends at any particular time and have an impact on the perception and implementation of specific health policies (Reinhardt, 1990). "
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    ABSTRACT: Contingency management (CM), despite the evidence base for its effectiveness, remains controversial, with sub-optimal implementation. In 2007, UK guidelines recommended the use of CM in publicly funded services, but uptake has also been minimal. Previous surveys of service providers suggest differences in opinions about CM, but to date there has been no published involvement of service users in this debate. Focus group methodology was used to explore systematically the attitudes, concerns and opinions of staff and service users about the use of CM, in publicly funded substance misuse services, to identify the key areas that may be influential in terms of implementation and outcome. Data were analysed thematically using the constant comparative method. 70 staff and service users participated in 9 focus groups. 15 themes of discussion around CM were identified, grouped into four categories: how CM was aligned to the philosophy of substance misuse services; the practicalities of implementation; wider ethical concerns; and how participants perceived the evidence for effectiveness. Robust process evaluation in different treatment systems is needed to define the active components of CM for implementation. Involvement of service users in this process is essential and is likely to provide valuable insights into the mechanism of action of CM and its effectiveness and uptake within complex treatment systems.
    Drug and alcohol dependence 06/2011; 119(1-2):56-63. DOI:10.1016/j.drugalcdep.2011.05.016 · 3.42 Impact Factor
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    • "In addition to our focus on the techniques of behavior change themselves, concerning which there are many technical aspects (e.g., Stitzer & Petry, 2006), we are also interested in how behavioral therapists and counselors attempt to engage their clients in the process of change. That is, the techniques of goal setting and contingency management, which are techniques used to change behavior within treatment settings, do not speak to the clinicians' orientation "
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    ABSTRACT: Motivation has received increasing attention across counseling approaches, presumably because clients’ motivation is key for treatment effectiveness. The authors define motivation using a self-determination theory taxonomy that conceptualizes motivation along a relative-autonomy continuum. The authors apply the taxonomy in discussing how various counseling approaches address client motivation and autonomy, both in theory and in practice. The authors also consider the motivational implications of nonspecific factors such as therapeutic alliance. Across approaches, the authors find convergence around the idea that clients’ autonomy should be respected and collaborative engagement fostered. The authors also address ethical considerations regarding respect for autonomy and relations of autonomy to multicultural counseling. The authors conclude that supporting autonomy is differentially grounded in theories and differentially implemented in approaches. Specifically, outcome-oriented treatments tend to consider motivation a prerequisite for treatment and emphasize transparency and up-front consent; process-oriented treatments tend to consider motivation a treatment aspect and give less emphasis to transparency and consent.
    The Counseling Psychologist 02/2011; 39(2):193-260. DOI:10.1177/0011000009359313 · 1.82 Impact Factor
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