Bright Spot: Prize Incentives Contingency Management for Substance Abuse
Photo by Külli Kittus on Unsplash
This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.
Prize Incentives Contingency Management for Substance Abuse is a variation of contingency management, or reinforcement, that provides adult substance users in community-based treatment with an opportunity to win prizes if they remain drug-free. This program augments existing, usual care services in community-based treatment settings for adults who primarily abuse stimulants (especially cocaine) or opioids (especially heroin) or who have multiple substance use problems.
Prize-based CM reinforces positive abstinent behavior in substance-abusing clients in treatment by providing them an opportunity to win various prizes when they provide negative urine and breath samples or complete treatment-related activities.
As of June 2014, the cost of this intervention is as follows:
- $50 each for Contingency Management for Substance Abuse Treatment: A Guide to Implementing This Evidence-based Practice (includes CD-ROM)
- $59 each for Training vignettes video (CD-ROM) - not required Rating Contingency Management Sessions That Reinforce Abstinence Using the Contingency Management Competence Scale (scale and manual)
- FREE The Contingency Management Competence Scale for Reinforcing Attendance (scale and manual)
- FREE $50-$200 per participant for 10-200 participants for 1- to 2-day off-site training - not required
- On-site consultation (contact developer directly for price) $100-$200 per hour for phone and email support
- The outcome results from the Petry and colleagues (2005) study found that patients in the treatment group who received prize incentives earned an average of 76.5 draws.
- The average total cost of the incentive procedure was $203 per participant, or $2.42 per participant per day.
For the latest cost details, please contact the Prize Incentives Contingency Management for Substance Abuse program contact person directly.
Key Steps for Implementation
- Designate a CM clinician. A single clinician may be designated to administer CM treatment to all eligible patients in the clinic. Alternatively, the primary clinician of each eligible patient could administer the procedures to their patient only
- A dedicated CM clinician should only administer the CM and not engage in other therapeutic interactions with patients who are being treated by other therapists
- Identify eligible patients
- Ask inclusion and exclusion questions to determine eligibility, and confirm with objective sources. Examples could include whether patients have been treated for drug abuse before, where they were treated, the drug they were using, etc.
- Explain to all patients who will be receiving incentives that they will be able to win prizes for coming into the clinic and testing drug-free.
- Inform them they will get to win the prizes by providing drug-free urine samples (or coming to treatment if attendance is the target behavior).
- Explain that there are small, medium, large, and jumbo prizes
- Maintain the prize cabinet
- Allow eligible patients to identify several prizes in the cabinet that s/he wants (get ideas from patients about incentive items)
- Track patient progress CM clinicians need to keep track of the number of draws based on patients' weeks in treatment and their urine sample test results
- Collect and test urine samples
- Review samples with patient and tell them they need to be negative from drugs or alcohol (specified by the chosen protocol) in order to draw for prizes
- Patients will earn at least one draw for each urine sample submitted that tests negative for the target drug
- Deliver rewards whenever the target behavior occurs
- Inpatient/Outpatient and other community settings
- Fishbowl (or empty jar) to be used for the draw slips
- Cabinet for prizes (label or arrange each category of incentives on one shelf of the cabinet to the extent possible)
- Incentive items:
- Jumbo items (maximum value of $100, average price of $70): Generally consist of electronic goods and small appliances. A $75 gift card to a retail store can also be used. Three jumbo prizes should be on display at all times
- Large items (maximum value of $20, average price of $14): Generally consist of watches, $15-20 gift certificates, clothing items, an AA Big Book, a back-pack, curling iron, make-up set, coffee pot, pot and pan sets, dishes, prepaid calling cards, etc. At least 15 different types of large items should be on display at all times
- Medium items (maximum value of $5, average price of $3.50): Generally consist of make-up, costume jewelry, t-shirts, underwear, wall clocks, coffee mugs, small daily planners, gloves, scarves, hats, laundry detergent, etc. Patients who receive several small prizes in a day may be allowed to take a larger prize in exchange (five smalls for a medium). About 20 different items should be available at any given time, and even more if many patients are participating as these items go quickly
- Small items (maximum value of $1, average price of $0.70): Generally consist of bus tokens, candy bars, food items, sodas, toiletries (soap, brushes, shampoo, toothbrushes, toothpaste), makeup, costume jewelry, and gift certificates to food outlets. Socks are a popular item, and a pack can be broken down into Individual/family pairs for incentives. About 75 items should be available at all times, representing at least 15 different categories.
Clinicians must complete a didactic seminar. Review the protocol-specific CM manual (description of the specifics of the CM protocol to be implemented in the clinical setting). Clinicians can then participate in several role-plays and practice exercises. Complete the Knowledge of Basic CM Principles questionnaire (Appendix 6.1 of this document).
Types of Staff
In the published research studies, CM usually has been delivered by research assistants, typically with bachelor's degrees in psychology. CM treatment can probably be delivered by anyone as long as they have good clinical judgment, are detail oriented, and have been trained in general behavioral principles and the CM techniques specific to the particular project.
- Drug use during treatment
- Drug use after treatment
- Drug problem severity during and after treatment
- Increased quality of life
- Treatment retention
- Abstinence from substance use
- Treatment attendance
- Group/counseling attendance