Contingency Management

Contingency management is a treatment approach that uses positive reinforcement to improve treatment outcomes by providing incentives to encourage behavioural changes, typically alcohol abstinence. Biological samples are collected periodically for verification of abstinence. The reward provided is often monetary, with the magnitude of the reinforcer increasing with sustained periods of abstinence. 

While evidence has shown that contingency management is effective in reducing illicit drug use in research settings, it has not been routinely translated into clinical practice due to resourcing problems and service level reluctance. Less evidence is available for alcohol dependence because implementing contingency management for alcohol poses additional difficulties. Unlike other substances, it is difficult to reliably detect recent alcohol use as neither blood nor breath tests can detect alcohol use that occurred more than 12 hours previously. The few treatment studies in alcohol dependence have employed daily (or more frequent) breathalyser testing and short follow-up assessment of outcomes. Developments in various technologies have begun to lower this technological barrier (e.g., remote breathalyser systems with identity verification, transdermal sensors, improved biomarkers). These developments may lead to larger, high quality studies with longer follow-up to strengthen the evidence base in alcohol dependence, and improve feasibility in clinical practice.

Chapter Recommendation Grade of recommendation
9.10 Contingency management for alcohol dependence may be effective in the short-term as an adjunct to standard care when used to reinforce biologically-verified abstinence that is assessed frequently (i.e., daily or more). C