• Contingency management. Using this method, addiction
counselors provide tangible incentives to encourage patients
to stay off drugs. Those rewards might include offering cash,
clinical privileges, work at a steady wage or even restaurant
vouchers for each clean drug test. Although these rewards might
seem small in comparison with the force of addiction, studies
have found that carefully structured contingency management
programs can help people stay clean.
These behavioral treatments can sometimes be particularly
effective when combined with pharmaceutical treatments that
either mimic the effects of the drug in a controlled way (such as
methadone and buprenorphine for opiate addiction or nicotine
chewing gum for cigarette addiction) or reduce or eliminate the
“high” the user gets from the drug (such as naltrexone for opiate
or alcohol addiction).
Different methods can also be effective for different
populations, and at different times in the treatment process.
For example, University of Vermont psychologist Stacy
Sigmon, PhD, who studies contingency management, says
that the technique can serve as a bridge to help people early
on. Drugs provide an immediate reward, whereas the rewards
of sobriety — better health, a stable job — can take longer to
“The idea is that these somewhat contrived voucher rewards
could really bridge that incentive delay,” she says. “If you can
string a few days or weeks [of sobriety] together, it really helps
[patients] get clear heads and make changes that move them
toward true, lasting sobriety.”
Unfortunately, solving America’s drug treatment problem will
not be as simple as requiring every licensed treatment program
to implement CBT, motivational interviewing or some other
evidence-based approach. That’s because some studies have
found that what works in the lab doesn’t always work as well in
Several examples come from the Clinical Trials Network
(CTN), a NIDA-sponsored initiative in which community
treatment programs implement and study evidence-based
treatment methods, according to John Kelly, PhD, associate
director of the Center for Addiction Medicine at Massachusetts
General Hospital in Boston. In one CTN study of more than
400 substance users for example, researchers compared using
motivational interviewing at a program’s first contact with a
substance user, with using a standard intake/evaluation session.
They found that although the MI method slightly improved
retention rates in the programs, it didn’t significantly improve
patients’ outcomes in the end.
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