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Contingency management treatments

  • Nancy M. Petry (a1)

Summary

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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Copyright

References

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Festinger, D. S., Marlowe, D. B., Croft, J. R., et al (2005) Do research payments precipitate drug use or coerce participation? Drug and Alcohol Dependence, 78, 275281.
Higgins, S. T., Budney, A. J., Bickel, W. K., et al (1994) Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry, 51, 568576.
Higgins, S. T., Wong, C. J., Badger, G. J., et al (2000) Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up. Journal of Consulting and Clinical Psychology, 68, 6472.
Lussier, J. P., Heil, S. H., Mongeon, J. A., et al (2006) A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction, 101, 192203.
McGovern, M. P., Fox, T. S. & Xie, H. (2004) A survey of clinical practices and readiness to adopt evidence-based practices: dissemination research in an addiction treatment system. Journal of Substance Abuse Treatment, 26, 305312.
Peirce, J. M., Petry, N. M., Stitzer, M. L., et al (2006) Lower-cost incentives increase stimulant abstinence in methadone maintenance community treatment: results of the National Drug Abuse Treatment Clinical Trials Network Multi-site Study. Archives of General Psychiatry, 63, 201208.
Petry, N. M. (2000) A comprehensive guide for the application of contingency management procedures in standard clinic settings. Drug and Alcohol Dependence, 58, 925.
Petry, N. M., Martin, B., Cooney, J. L., et al (2000) Give them prizes and they will come: contingency management for the treatment of alcohol dependence. Journal of Consulting and Clinical Psychology, 68, 250257.
Petry, N. M. & Martin, B. (2002) Lower-cost contingency management for treating cocaine-abusing methadone patients. Journal of Consulting and Clinical Psychology, 70, 398405.
Petry, N. M., Alessi, S. M., Tedford, J., et al (2005a) Vouchers versus prizes: contingency management for treatment of substance abusers in community settings. Journal of Consulting and Clinical Psychology, 73, 10051114.
Petry, N. M., Peirce, J. M., Stitzer, M. I., et al (2005b) Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study. Archives of General Psychiatry, 62, 11481156.
Petry, N. M., Kolodner, K. B., Li, R., et al (2006) Prize-based contingency management does not increase gambling. Drug and Alcohol Dependence in press.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Contingency management treatments

  • Nancy M. Petry (a1)
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eLetters

Contingency management treatment

Ian G Bronks, consultant psychiatrist
09 August 2006

Petry summarises evidence from studies conducted in the USA indicating that "contingency management treatment"- in other words, money-is efficacious in enhancing the duration of abstinence in drug and alcoholmisusers.

Unsurprisingly it appears that the more the individuals concerned arepaid, the more likely they are to abstain.

It is obvious that those who abstain from drugs or alcohol in the hope or expectation of material reward could have done so without such rewards, had they wished to.

Most people will feel a natural sense of repugnance at the idea of paying people to refrain from antisocial or even criminal behaviour such as drug or alcohol misuse. Such a procedure, with its appeal to naked greed,is as Petry suggests, doubtless consistent with the values embedded in present day American society, and indeed our own. That it should be dignified with the respectable sounding title of "contingency management treatment" is equally distasteful.

Where is the line to be drawn? Should we pay paedophiles if they refrain from molesting children, or thieves if they stop stealing? Contrary to what Petry seems to believe, the end does not always justify the means.

We do need a serious debate, both within the psychiatric profession and more widely, about the extent to which those who choose to misuse drugs and other substances should be regarded as patients, requiring treatment,coupled with an objective evaluation of the extent to which society benefits from the vast sums of money poured into services for drugand alcohol misusers. If Petry's editorial helps to trigger such a debate it will have served a useful purpose.Yours faithfully

Ian G Bronks F.R.C.P.(Ed.), F.R.C.Psych.64 BroadwayDuffieldDerbyshireDE56 4BU

Tel: 01332 841438Fax: 01332 843660
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Conflict of interest: None Declared

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