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.

Identifying Triggers:

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 System:

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 Testing:

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.

Promoting Self-Efficacy:

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.

Individualized Treatment:

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.[1],[2],[3],[4],[5],[6],[7],[8] 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.[9]
 
CM is one of the most extensively validated substance use interventions.[10],[11],[12] 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.[13],[14],[15],[16],[17] A variation of CM developed by Azrin, Donohue, and colleagues produced positive results with adolescents in several studies.[1],[18],[19],[20] 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.[19] Positive effects of CM for adolescents have been replicated by others (e.g., [21],[22],[23],[24]). 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.


References:

[1]Azrin, N. H., Donohue, B., Besalel, V. A., Kogan, E. S., & Acierno, R. (1994). Youth drug abuse treatment: A controlled outcome study. Journal of Child and Adolescent Substance Abuse, 3, 1-16.

[2]Bry, B. H., & Krinsley, K. E. (1992). Booster sessions and long-term effects of behavioral family therapy on adolescent substance use and school performance. Journal of Behavior Therapy and Experimental Psychiatry, 23(3), 183-189.

[3]Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002). Four-year follow-up of MST with substance-abusing and dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41(7), 868-874.

[4]Henggeler, S. W., Pickrel, S. G., & Brondino, M. J. (1999). Multisystemic treatment of substance-abusing and -dependent delinquents: Outcomes, treatment fidelity, and transportability. Mental Health Services Research, 1(3), 171-184.

[5]Kaminer, Y., Blitz, C., Burleson, J. A., Sussman, J., & Rounsaville, B. J. (1998). Psychotherapies for adolescent substance abusers: Treatment outcome. Journal of Nervous and Mental Disease, 186, 684-690.

[6]Liddle, H. A., Dakof, G. A., Diamond, G., Parker, K., Barrett, K., & Tejeda, M. (2001). Multidimensional family therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse, 27, 652-687.

[7]Waldron, H. B., Slesnick, N., Brody, J. L., Turner, C. W., & Peterson, T. R. (2001). Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of Consulting and Clinical Psychology, 69, 802-813.

[8]Waldron, H. B., & Turner, C. W. (2008). Evidence-based psychosocial treatments for adolescent substance abuse. Journal of Clinical Child and Adolescent Psychology, 37, 238-261.

[9]Hogue, A., Henderson, C. E., Becker, S. J., & Knight, D. K. (2018). Evidence base on outpatient behavioral treatments for adolescent substance use, 2014-2017: Outcomes, treatment delivery, and promising horizons. Journal of Clinical Child and Adolescent Psychology, 47(4), 499-526.

[10]Higgins, S. T., Silverman, K., & Heil, S. H. (Eds.) (2008). CM in substance abuse treatment. New York, NY: Guilford.

[11]Prendergast, M., Podus, D., Finney, J., Greenwell, L., & Roll, J. (2006). Contingency management for treatment of substance use disorders: A meta-analysis. Addiction, 101, 1546-1560.

[12]Lussier, J. P., Heil, S. H., Mongeon, J. A., Badger, G. J., & Higgins, S. T. (2006). A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction, 191, 192-203.

[13]Petry, N. M., Peirce, J. M., Stitzer, M. L., Blaine, J., Roll, J. M., Cohen, A., . . . Kirby, K. C. (2005). Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry, 62(10), 1148-1156.

[14]Peirce, J. M., Petry, N. M., Stitzer, M. L., Blaine, J., Kellogg, S., Satterfield, F., . . . Li, R. (2006). Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry, 63, 201-208.

[15]Hanson, T., Alessi, S. M., & Petry, N. M. (2008). Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. Addiction, 103(7), 1187-1197.

[16]Petry, N. M., Alessi, S. M., & Hanson, T. (2007). Contingency management improves abstinence and quality of life in cocaine abusers. Journal of Consulting and Clinical Psychology, 75(2), 307-315.

[17]Petry, N. M., Alessi, S. M., & Rash, C. J. (2013). Contingency management treatments decrease psychiatric symptoms. Journal of Consulting and Clinical Psychology, 81(5), 926-931.

[18]Azrin, N. H., Acierno, R., Kogan, E. S., Donohue, B., Besalel V. A., & McMahon, P. T. (1996). Follow-up results of supportive versus behavioral therapy for illicit drug use. Behaviour Research and Therapy, 34, 41-46.

[19]Azrin, N. H., McMahon, P. T., Donohue, B., et al. (1994). Behavior therapy for drug abuse: A controlled treatment outcome study. Behaviour Research and Therapy, 32(8), 857-866.

[20]Donohue, B., & Azrin, N. H. (2001). Family behavior therapy. In E. F. Wagner, H. B. Waldron (Eds.), Innovations in adolescent substance abuse interventions. New York, NY: Pergamon Press.

[21]Henggeler, S. W., Halliday-Boykins, C., Cunningham, P. B., Randall, J., Shapiro, S. B., & Chapman, J. E. (2006). Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74, 42-54.

[22]Henggeler, S. W., McCart, M. R., Cunningham, P. B., & Chapman, J. E. (2012). Enhancing the effectiveness of juvenile drug courts by integrating evidence-based practices. Journal of Consulting and Clinical Psychology, 80(2), 264-275.

[23]Stanger, C., Budney, A. J., Kamon, J. L., & Thostensen, J. (2009). A randomized trial of contingency management for adolescent marijuana abuse and dependence. Drug and Alcohol Dependence, 105(3), 240-247.

[24]Stanger, C., Ryan, S. R., Scherer, E. A., Norton, G. E., & Budney, A. J. (2015). Clinic- and home-based contingency management plus parent training for adolescent cannabis use disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 54(6), 445-453.