Patients who have problems with drugs and alcohol will respond to different types of treatment depending on the severity of their addiction. Contingency management is one of many behavioral treatment plans that the Veterans Health Administration and other hospitals have been using to treat substance abuse and similar types of behaviors.
It has been found to be effective when treating dependency on various types of substances including opioids, alcohol, stimulants, nicotine, and marijuana, just to name a few. The ultimate goal is to get more states on board to use this type of treatment.
What Is Contingency Management?
Many states have started to allow VA hospitals the option to use contingency management therapy, or motivational incentives when treating veterans who are dealing with addiction or substance abuse problems. Incentives can include movie tickets, gift certificates, passes to a local event, or even money. Based on operant conditioning, this type of therapy rewards desired behaviors. Disciplinary action is taken if undesirable behavior is recorded.
While this may seem like an easy trade-off, veterans work hard to maintain their sobriety and get more rewards from regaining their health than the material rewards received through the treatment program. Working hard to receive a reward is much the same as working towards a goal. The only difference is that you receive something for your hard work instead of simply the satisfaction of completing a milestone.
Who Has Used It for Vets?
The Veterans Administration has used contingency management therapy for several years — long enough to know that it works effectively on the majority of patients who are treated with it. While many people don't agree with the “rewarding good behavior” tactics, others look at it like effective motivational tools. Motivation is a big issue for many servicemen and women who return home to a less structured environment and have difficulty adjusting.
Many soldiers who have returned home and found themselves on the streets and abusing drugs and alcohol have very few things to motivate them to get better. The VA looks at contingency management as a way to motivate them back to good health, one step at a time. In a way, it gives them back some of the structure they had while they were enlisted. For many, it is the loss of that structure that they find so difficult to overcome.
What Are the Results of Contingency Management?
With over 20.4 million Americans (many of them veterans) admitting to some type of substance abuse in 2019, the numbers continued to rise in 2020. Studies performed across the country in VA hospitals have shown that contingency management is effective when used on its own or as part of a much broader behavioral health treatment plan.
About 70 clinics have implemented contingency management treatment in their facilities since 2011, but the push to get it established in more clinics has faltered. According to the findings at several VA hospitals over the last 40 years, contingency management is extremely effective, showing consistent abstinence in patients with substance abuse disorders.
Should More States Be Using It?
Contingency management has been proven time and again that it is effective when dealing with most substances. So why aren't more VA hospitals and rehab facilities using it? For some, the sticking point seems to be the rewarding of bad behavior. Some critics also believe that patients shouldn’t be rewarded for doing things they should already be doing. There are also naysayers who believe that the patient may sell their rewards so they have the money to buy other things.
Part of the reason that contingency management isn't being used is that most insurers (public and private alike) will not pay for it. They will, however, pay for treatments like methadone. Federal agencies like the Department of Health and Human Services have failed to support the treatment program, even though it is well-known that it works.
Contingency management techniques are effective and they are being implemented in certain facilities aside from the Veterans Administration. The goal of many veterans, as well as the behavioral therapists who work with them, is to bring contingency management to more VA hospitals and rehab facilities across the country. This will enable more veterans to receive the quality healthcare they need to overcome their substance abuse issues in a safe and effective manner.
Sources
- - VA Homeless Programs: Contingency Management
- - Contingency Management: What It Is and Why Psychiatrists Should Want to Use It
- - Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis
- - Contingency Management Helps Veterans Stay Drug-Free
- - Nationwide dissemination of contingency management: The Veterans Administration Initiative
- - Contingency management for treatment of substance abuse disorders: a meta-analysis
- - Contingency Management Strategies and Ideas
- - This Addiction Treatment Works. Why Is It So Underused?
- - Drug Rehab in Huntington Beach, CA
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