Contingency management for abstaining from recreational drugs: Discussion for the learning or therapy chapters

What information do public policy makers need to help them decide if we should use public funds to pay people who are addicted to recreational drugs to stay clean?

Before giving students this question, provide a bit of background.

With opioid addiction, drug treatment providers have medications that can help suppress cravings. With reduced cravings, a person with the addiction can work on the life changes needed to stay off opioids for good. However, with some drugs, such as methamphetamine, there are no such medications.

Operant conditioning research tells us that if you want a rat to learn to press a bar, the initial bar presses must be reinforced immediately. If we wait until, say, bar press 78 to provide the first reinforcement, bar press 78 will never come. Our rat will have given up on bar pressing long before then. To bring this closer to the lives of your students, ask them to imagine having a job where they don’t get paid for a year. How long do they think they would continue working before giving up?

Similarly, there are inherent rewards that come with staying away from recreational drugs, such as stable employment, stable housing, and stable relationships, but there can be a long time between stopping drug use and reaping those rewards (78 bar presses!). Contingency management treatment provides rewards for those initial efforts at staying drug free and continues those rewards until the bigger rewards of life stability fall into place. We can think of such programs as a way to bridge the reinforcement gap. When program participants demonstrate that they have not used since their last test, they receive (what is expected to be) positive reinforcement.

Invite students to work in small groups to answer this question: What information do public policy makers need to help them decide if we should use public funds to reinforce people who are addicted to drugs to stay clean?

Students may want to know how much money it takes to provide reinforcement. The programs typically ramp up reinforcement with small amounts at the beginning and larger amounts the longer a person stays clear. As reported in a (gifted to you) New York Times article, program participants “typically come in twice a week for a urine drug screen. If they test negative, they are immediately handed a small reward: a modest store voucher, a prize or debit card cash. The longer they abstain from use, the greater the rewards” (Hoffman, 2025). One program reported in that article gave $10 for the first clean test and $12.50 for the second one later that week.

A meta-analysis of 23 studies (32 contingency treatments for a variety of drugs) found that 91% of the treatments increased the size of the reinforcement with each successful drug screening. The frequency of reinforcement was from one to seven times per week. The average amount of money that a person could earn over the span of the treatment was $914.46; the median was $466 (Ginley et al., 2021).

Students may want to know how many participants remain drug free after the program ends. One meta-analysis found that “participants who received CM evidenced a 22% greater likelihood of abstinence at a median of 24 weeks after reinforcement ended than participants receiving comparison treatments” (Ginley et al., 2021, p. 65).

If time allows, conclude this discussion by asking students to consider how contingency management treatments could work for other life changes, such as eating better or exercising more. These are areas of our lives where the inherent rewards of better health and greater mobility come much later—78 bar presses later. Invite students to work in small groups to design a research study that would investigate the use of contingency management for exercise or eating better. The design should specify reward frequency, reward amounts (increases over time?), the behavior being rewarded, length of the program, measure of effectiveness, evaluation of long-term effectiveness, and the identification of a control condition. At the conclusion of discussion, invite groups to share their research designs.

If you’d like your students to have some library database searching practice, ask students to find a study that addresses this research question. In a brief report, ask students how the study addressed each of the design elements asked above. The ones that are most likely to be missing are measures of long-term effectiveness and the presence of a control condition.

References

Ginley, M. K., Pfund, R. A., Rash, C. J., & Zajac, K. (2021). Long-term efficacy of contingency management treatment based on objective indicators of abstinence from illicit substance use up to 1 year following treatment: A meta-analysis. Journal of Consulting and Clinical Psychology, 89(1), 58–71. https://doi.org/10.1037/ccp0000552

Hoffman, J. (2025, July 16). Upended by meth, some communities are paying users to quit. The New York Times. https://www.nytimes.com/2025/07/16/health/meth-addiction-treatment-contingency-management.html