Association for Behavior Analysis International

Over 50 years of research supports the view that drug taking is operant behavior, and that behavior analytic principles and procedures can be therapeutically applied to the problem of drug abuse. The core of the "contingency management" approach to reinforcing drug abstinence is to deliver material goods or services contingent upon biologically verifiable evidence of drug abstinence. Such interventions are especially notable in that (1) they now stand out as the most effective psychosocial approach to drug abuse treatment; and (2) no other application of behavior analysis has been so thoroughly tested in randomized controlled trials, the gold standard for medical research. This symposium will cover previous and ongoing research related to the contingency management, and is intended to be highly accessible for the uninitiated, as well as informative and enjoyable for those with experience in the area. The first presentation will include reviews of early studies of drug self-administration and randomized controlled trials of the contingency management approach to drug abuse treatment. The second presentation will describe current efforts to disseminate contingency management and expand the targets of the interventions broadly throughout behavioral medicine. Our esteemed discussant will then offer his thoughts on the history and future of contingency management.

The idea that individuals struggling with drug abuse could be successfully treated by paying them when they abstain from drug use seems farfetched, at least to some people. But this unique approach is based on decades of research demonstrating unequivocally that drug use is sensitive to its consequences. This presentation will begin with a review of laboratory precursors to contingency management, including dramatic studies that demonstrate the lethality of drugs of abuse, the cross-species generality of addiction to many drugs, and the amazing power of money in shifting choices away from drug use. We will then turn to randomized controlled trials (RCT) of contingency management that have demonstrated the efficacy of this approach in drug abuse treatment. Although foreign to most behavior analysts, the use of RCTs has been critical to the success of contingency management in gaining support in the academic medical community and in national agencies in the US and abroad. This presentation will feature a guided tour of RCTs that have been conducted over the last 30 years showing that contingency management can be effective in addressing a variety of drug abuse problems, with an emphasis on a contingency management intervention called the Therapeutic Workplace.

On the heels of the successes of contingency management interventions in randomized controlled trials, substantial efforts have been made to disseminate contingency management interventions. Some dissemination efforts have relied on promoting the use of contingency management via the existing treatment infrastructure, especially outpatient drug abuse treatment clinics. Prize-contingency management, for example, is being instituted in VA clinics nationwide. Other efforts have focused on the development of technologies that allow for electronic distribution of contingency management interventions. Benefits and challenges of these methods will be discussed. In addition to the dissemination of contingency management as a drug abuse treatment, contingency management researchers have increasingly turned their attention to new behavioral targets in an effort to explore the broad utility of the contingency management approach in preventive medicine. A guided tour of these expansion efforts will be presented, with special focus on the target of exercise. In summary, this presentation will highlight efforts to disseminate contingency management as a drug abuse treatment and as a smoking cessation treatment, and illustrate how the same kinds of methods used to treat drug abuse can be applied to other preventive medicine targets, including diet and exercise, self-monitoring in diabetes, vaccination, and medication adherence.