CM Treatment Approach
Contingency Management (CM) is a scientifically-proven method for reducing substance use in teens. Grounded in principles of behavior management and cognitive-behavior therapy (CBT), CM identifies factors that contribute to teen substance use and offers a replacement system of incentives and disincentives to encourage drug abstinence and prosocial behaviors. CM typically lasts 20-24 outpatient sessions, with sessions occurring at least once per week. However, as the teen progresses, sessions might occur less frequently. The core components of CM include:
Engaging the Family:
CM is a family-based treatment. Therefore, a parent, or another responsible adult, participates directly in CM. The parent plays a key role in helping identify triggers for teen drug use, monitoring and supervising the teen between sessions, implementing a rewards plan, and assisting with the long-term recovery plan.
CM therapists guide the family through determining the triggers that lead the teen to use drugs, and the people, places, thoughts, and feelings that help in avoiding use.
Self-Management & Drug Refusal Skill Training:
Drawing on CBT and behavioral strategies, the CM therapist helps teens develop skills to avoid high-risk situations and cope with the unavoidable ones.
Rewards provided by CM aim to replace those which sustain drug use, while simultaneously weakening the power of substances in influencing behavior. Rewards are both non-monetary (e.g., privileges) and monetary (e.g., vouchers) that the teen finds desirable. These are regularly provided (or taken away) depending on the results of the teen’s drug screens.
Drug screens are used as an objective, measurable assessment of drug use. They are administered during sessions, other appointments, and at home by the teen’s parent, at intervals determined by the adolescent’s drug of choice and at high-risk times.
Later stages of CM focus on reinforcing skills and planning for addressing future struggles. CM prioritizes long-term recovery through building teen and parent skills.
CM is individualized to the strengths and needs of each teen and parent. Therefore, it is culturally competent and strengths-based. Effective techniques for overcoming barriers such as parent involvement or mental health symptoms have been developed, and on-going support for troubleshooting these and any other issues is included as part of the CM training.
Scientific Research Supporting CM
Research on outpatient treatment of teen substance use supports the effectiveness of behavioral and cognitive-behavioral techniques.,,,,,,, These techniques have primarily been proven successful within family-based treatments, and family-based models have garnered most of the support in the substance use treatment field.
CM is one of the most extensively validated substance use interventions.,, For example, large clinical trials have shown that CM achieves higher rates of abstinence, longer durations of abstinence, higher rates of treatment completion, better quality of life, and lower mental health symptoms and HIV-risk behaviors.,,,, A variation of CM developed by Azrin, Donohue, and colleagues produced positive results with adolescents in several studies.,,, Randomized trials of this CM variation demonstrated significantly better outcomes for youth in CM conditions, compared with supportive counseling, for drug use abstinence, mental health and conduct problems, and employment/school attendance. Youth receiving CM were eight times more likely to be abstinent compared to youth receiving supportive counseling. Positive effects of CM for adolescents have been replicated by others (e.g., ,,,). Importantly, the recent research on CM for adolescent substance use has relied on community-based outpatient therapists showing that effective treatments exist and, if implemented with fidelity, these treatments can decrease substance use and improve adolescent functioning.
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