HOUGHTON — Recently, a group called White Hot PR, issued a release stating that more than one in four Michigan residents support a program using tax money to pay addicts to stay sober. The release states that “‘Michiganders support the idea of paying addicts $605 to stay sober,” adding that “half think the incentives should be an outright cash payment.” That is, half of one in four who support such a program.

White Hot PR reported that the Sunrise House Treatment Center, a New Jersey-based provider of addiction treatments (SunriseHouse.com), polled 3,757 respondents to gauge their thoughts on implementing a similar monetary incentive-based strategy in their own state. It was found that 27% of Michigan residents said they would support a recovery program that proposed using tax dollars to pay addicts to stay sober. Furthermore, the average monetary amount Michiganders think would be a fair payment to complete the program is $605 (compared to a national average

of $579). White Hot PR (info@whitehotpr.com) is a public relations and content agency that provides media, its website states, with informative and engaging content for their readers.

“Frustrated by continually rising drug overdose statistics,” White Hot PR stated, “the state of California recently proposed a radical solution strategy: paying victims of addiction to stay sober. In 2020, the CDC reported that drug overdose deaths spiked by 29.7%, reaching the highest number ever recorded in a 12-month span – more than 93,000 deaths.” The solution strategy is not radical, nor it is even new. In fact, Contingency Management, as it is referred to, has been around since the 1960s.

Researchers began studying Contingency Management (CM) as an intervention for alcohol use disorder in the 1960s, states the Recovery Research Center (www.recoveryanswers.org).

“Also during this time, other more involved treatment approaches capitalized on these operant conditioning principles present in CM,” The RRC states, “while also incorporating ways to enhance coping skills and sober social activities, such as the Community Reinforcement Approach (CRA).”

As proposed by California, the payment program would use tax dollars to pay people small incentives for every negative drug test they provide over a certain period of time. Those who complete the treatment without failing any of these tests can earn a substantial reward, which would typically be contingency management in the form of a gift card. This contingency management strategy based on an immediate reward incentive is not a recent concept; in fact, the federal government has been implementing similar strategies for a number of years to assist military veterans recovering from addiction. Research has shown to be effective in the treatment of stimulant addiction, such as cocaine and methamphetamine – for which there is currently no medical treatment available – as well as alcohol, opioids, marijuana and nicotine. But what is contingency management, and what is the research behind it?

According to a study published last month by the U.S. National Institutes of Health’s National Library of Medicine (NIH/NLM), CM refers to a behavioral therapy in which positive reinforcers are provided to individuals who misuse substances contingent upon objective evidence of abstinence. Usually, reinforcers are chances to win prizes of varying magnitudes or vouchers, exchangeable for retail goods and services.

However, CM is not without its detractors. According the article, one consistently mentioned issue is that the behavior will revert to active using once reinforcers are no longer offered. In some laboratory-based CM demonstration projects and clinical trials, drug use returns to pre-intervention rates when reinforcers are no longer provided. The Sunrise House Treatment Center’s study report, as released by White Hot PR, does tell the complete story, however, leaving many with the same misinformation.

The study did not make clear whether contingency management was the sole strategy employed in motivating the patient to stop.

Vertava Health, a Texas-based Joint Commission accredited residential treatment center found outside of Dallas in the woods of eastern Texas, stated on its website (vertavahealthtexas.com) that CM is used to “encourage sobriety and behaviors that support healthy living.” Clients receive rewards when they obtain positive goals and make lifestyle changes within their day-to-day lives, the site states. Examples include drug-free urine specimens or consistent treatment attendance. But that is not all there is to it.

Contingency management can be especially beneficial for individuals who are unable to take certain medications for managing addiction or for those who only have limited success using these treatments, Vervata goes on to state. Used with medications and/or other treatment therapies, contingency management may increase treatment retention rates and improve a client’s chance of sobriety and recovery success.

A report published by Nancy M Petry, PdD, in Psychiatric Times in 2002 (www.psychiatrictimes.com) found that a series of studies demonstrated that contingency management is effective in retaining patients in treatment and reducing substance use. One study randomly assigned cocaine-dependent outpatients to 12-step-oriented treatment or a CM treatment in which they received individual behavioral therapy in conjunction with vouchers every time they provided a drug-free urine specimen. Patients assigned to the CM group remained in treatment significantly longer and reduced cocaine use relative to patients in the 12-step group.

A subsequent trial in the same study evaluated whether it was the provision of the contingent vouchers, as opposed to the behavioral therapy, that engendered the improved outcomes. This study provided intensive behavioral therapy to another sample of cocaine-dependent outpatients, but one group received vouchers contingent upon drug abstinence while the other group did not. Three-quarters of the patients in the voucher condition completed treatment, compared with 40% of patients who received the same behavioral therapy without the vouchers. Over half the patients who received vouchers achieved at least 10 weeks of continuous cocaine abstinence versus 15% in the non-voucher condition.

The Lighthouse Recovery Institute on Feb. 10, published an article (lighthouserecoveryinstitute.com) by Geraldine Orentas that cautions: “Although successful, contingency management on its own won’t be effective.”

To be successful, Orentas continued, CM must be part of an integrated treatment care plan. Intensive psychotherapy is necessary to help someone overcome the root cause of addiction and attend any co-occurring mental disorder, she states. Integrated care often involves cognitive-behavioral therapy and dialectical-behavioral therapy.