Contingency management in the treatment of substance use disorders: A historical narrative.

Abstract

This narrative provides an overview of contingency management (CM) in the treatment of substance use disorders (SUDs) from inception to present day. Highlights and examples are selected by a founder in the field and follow her research lineage. Positive reinforcement interventions that could counter the powerful reinforcing effects of abused drugs and promote abstinence were introduced in demonstration studies during the 1960's and 70's at Johns Hopkins. Subsequent innovators developed formal treatment interventions using monetary-based vouchers (Higgins) and prize draws (Petry) as rewards for objective evidence of recent drug abstinence. CM research subsequently flourished using these delivery models, demonstrating efficacy and generality across populations. Recently, with advent of remote drug/alcohol testing, CM treatments have been adapted for digital delivery via phone apps. This development along with advocacy for use of evidence-based treatments, may further boost clinical adoption. It is notable that a treatment model, grounded in behavioral psychology concepts and incorporating the most rigorous behavioral principles, has proven to be sufficiently efficacious to support a robust research and policy enterprise for over 50 years.