1st Edition

Contingency Management for Substance Abuse Treatment A Guide to Implementing This Evidence-Based Practice

By Nancy M. Petry Copyright 2012
    334 Pages 1 B/W Illustrations
    by Routledge

    334 Pages
    by Routledge

    Isn’t it unethical to pay people to do what they should be doing anyway?
    Won’t patients just sell the reinforcers and buy drugs?
    Others didn’t get prizes for not using. Why should they?

    The concerns surrounding Contingency Management (CM) are many and reflect how poorly understood and rarely utilized this evidence-based treatment model is in practice settings. Despite being identified as the most efficacious intervention for substance use disorders, a significant gap persists between research and practice, at the client’s expense. Nancy Petry, an experienced researcher and consultant for organizations such as the National Institute of Health, has begun to fill this gap by authoring the first clinician-oriented text that focuses on CM protocol development and implementation. In this well-organized and clear book she provides a foundation for understanding CM and details how to design and implement a program that can work for any clinician, whether he or she works for a well-funded program or not. She also addresses realistic concerns such as:

    • How to describe CM to eligible and ineligible patients
    • How to calculate the costs of CM interventions
    • How to solicit donations and raise funds to support CM interventions
    • How to stock a prize cabinet and keep track of prizes

    Over 50 charts, worksheets, and tables are provided to help the clinician pinpoint exactly which behaviors to target, brainstorm how to reinforce change, and develop a treatment plan that incorporates cost, length of treatment, and method for determining patient compliance. Included with the book are downloadable resources of editable logs, forms, tables, and worksheets for personal use. More than just filling a void, Dr. Petry provides all of the tools clinicians require to successfully apply a novel treatment in practice.

    Part I: Introduction
    Chapter 1: Background - The initial section of the book will provide an overview and rationale for contingency management (CM). It will briefly note the efficacy of the technique and will acknowledge some of the common criticisms and barriers to CM and how they can be overcome. This chapter will also detail some real world case examples of clinicians and clients who have designed and participated in CM programs.

    Chapter 2: A Brief History of Behavioral Treatments and the Evolution of CM - This chapter will define CM treatment and describe its similarity to other behavioral interventions that have been and are still in use today. It will also delineate how these interventions were first adapted toward substance abusing populations. Finally, it will highlight the use of CM in methadone maintenance treatment as another example of how research was translated into clinical practice.

    Chapter 3: Empirical Evidence of the Efficacy of CM - This chapter will review the research literature on CM that illustrates the efficacy of CM in several populations. It will also detail the types of reinforcers utilized, ranging from clinical privileges, to vouchers and prizes.

    Chapter 4: Applications of CM in Novel Settings and with Special Populations - The author will describe evidence for and applications of CM beyond primary substance using populations and will review specific studies that applied CM procedures to behaviors other than drug abstinence as examples of the generalization of CM techniques.

    Part II: Developing a CM Protocol for Use in Practice
    Chapter 5: Selecting a Target Behavior - This chapter will assist with decision-making processes in selecting the focus for an initial CM protocol and will review different behaviors that can be quantified and reinforced.

    Chapter 6: Choosing a Target Population - This chapter will articulate the pros and cons of clinic-wide versus a targeted approach toward CM administration and provide rationales for how and why CM can be administered to some, but not all, clients in a clinic. The chapter will also include case examples, worksheets, and flowcharts to help the reader characterize their goals for using CM in their setting and with their patient population.

    Chapter 7: Selecting Behavior Monitoring Schedules - This chapter will focus on choosing a behavior monitoring schedule as the next step in designing a CM protocol.

    Chapter 8: Reinforcers to Use - This chapter will review the advantages and disadvantages of various types of reinforcers, tying in information presented from earlier chapters. It will detail the use and types of the three most common reinforcers: clinic privileges, vouchers, and prizes.

    Chapter 9: Designing Reinforcement Schedules - Using worksheets and examples, this chapter will detail typical voucher and prize reinforcement schedules. In addition, it will discuss variants on these approaches that retain the use of appropriate behavioral principles. The chapter will also depict examples of less than ideal schedules so that clinicians can better critique their own CM plans.

    Chapter 10: Calculating Costs of a CM Program - The primary purpose of this book is to assist clinicians in designing and implementing feasible and realistic CM programs. Thus, this chapter will emphasize methods for reducing costs while maintaining essential behavioral features.

    Chapter 11: Raising Funds to Support CM - This chapter will detail a variety of options for raising funds for CM, along with advantages and disadvantages of each approach. It will include examples such as soliciting donations; clinics supporting initial costs with the expectations that increased reimbursement for retention and attendance will occur; writing for state pilot, demonstration, or grant funding; and using fee rebates and having clients pay a deposit.

    Chapter 12: Implementation Issues - This chapter will outline specific issues associated with implementation including: how to describe CM to the other clinicians and staff, how to address common staff concerns, how to talk with eligible clients about participating in a CM program, and how to explain non-participation in ineligible clients. A section will also detail common problems that arise in CM implementation, as well as the need for frequent monitoring and supervision of staff.

    Chapter 13: A Step-by-Step Guide for Implementing Prize CM for Abstinence - This chapter will describe all the steps necessary for implementing prize CM. It will include all necessary worksheet and flow charts and examples of prizes in each category.

    Chapter 14: A Step-by-Step Guide for Implementing the Name-in-the-Hat Prize CM for Group Attendance - Using a manual successfully applied in over 20 clinical settings, this chapter will specifically detail the Name-in-the-hat prize CM procedure for reinforcing group attendance.

    Chapter 15: Summary - The final summary chapter will review the rationale for designing and implementing CM programs. It will encourage clinicians in the development of such programs to improve the outcomes of the clients they treat, which in turn may make their own jobs more rewarding.



    Nancy M. Petry, PhD, is Professor of Medicine in the Calhoun Cardiology Center at the University of Connecticut and serves as a consultant and advisor for the National Institutes of Health.

    “Dr. Nancy Petry shares the wisdom gleaned from her extensive experience in developing, testing, and training innovative CM interventions for substance users.  She demonstrates how to develop a CM program and provides helpful examples of patient-clinician dialogues and supervision methods. This outstanding resource is the first of its kind.” - Maxine Stitzer, Johns Hopkins University School of Medicine, Maryland, USA

    “This book represents an important step towards proper dissemination of Contingency Management. Organizations and programs interested in implementation will find it useful for the purposes of designing CM protocols, as well as for training clinical staff in the basic tenets of CM. The book not only offers practical 'how to' information, but also provides step-by-step guides and worksheets that can be directly applied to clinical practice.” - Lissa Dutra, Boston Institute for Psychotherapy, USA
    “Dr. Petry’s latest contribution to the literature on Contingency Management is both scholarly and pragmatic. It is highly recommended for clinicians and trainees in the mental health and substance abuse fields, who will learn the state of the art of evidence-based CM as well as how to practically implement this approach in a variety of clinical situations for different  sub-populations.” - Yifrah Kaminer, University of Connecticut Health Center, USA