Recent headlines have brought attention to efforts to ‘gamify’ addiction treatment, a word that, in some cases, is intended as a pejorative.
It refers to efforts by some cities, with encouragement from the Biden Administration, to create a rewards-based system for encouraging positive behavior in treatment.
What Does ‘Gamifying’ Addiction Treatment Mean?
‘Gamifying’ addiction has been used to refer to some applications of an evidence-based treatment modality called contingency management (CM).
CM uses a system of rewards for positive behavior that indicates sobriety.
For example, every time clients in a treatment program get a clean drug test, they receive a star or point that is connected to a predetermined system of rewards.
Recent Efforts At Contingency Management In The News
CM has been used in treatment facilities for many years. However, it has recently garnered media attention in some cities.
Seattle, in particular, has begun implementing the principle of CM in a variety of ways.
Change In Payment Levels Under Biden Administration
In previous years, addiction treatment facilities had a cap on the amount of money clients could receive through a contingency management approach.
It was determined that money given to clients could be viewed as kickbacks for attending a specific treatment program, so the cap was set at $75.
In 2022, a legal opinion from the Inspector General mitigated civil and criminal penalties that a Boston-based treatment center faced for giving individual clients a total of $599 in rewards.
Based on this, a recovery center that uses contingency management can set a limit of rewards much higher than it previously could.
Seattle Adopts A Contingency Management Program
Seattle is one of many cities in Washington State that recently adopted a contingency management program.
According to the Mayor’s Office, this 12-week pilot program will target people who need treatment by offering them rewards in the form of cash or gift cards for sobriety.
Criticisms Of The Seattle Program
Critics of the program state that it is bribing people to stay off drugs while giving them the means with which to fund their addiction.
However, the program only gives clients rewards when they have a clean drug test. If the client uses the money for drugs, the idea is that the reward system will not apply.
What is unique about this program is that it is administered to clients at whatever location they call home.
It is not administered through an onsite free treatment program where CM is traditionally used in conjunction with other therapies.
How Does Contingency Management Work?
CM uses a rewards-based system to provide clients with incentives to pursue sobriety. These incentives can act as motivation.
The rewards-based approach of CM can take two different forms: voucher-based reinforcement and prize-based reinforcement.
Voucher-based reinforcement takes a community-wide approach to reinforce drug-free behavior.
Essentially, when clients receive a reward it comes in the form of a voucher for services in the community. Clients can exchange these vouchers for things like food, clothing, or movie passes.
Prize-based incentives work more like a raffle or drawing. Clients that have a drug-free test can draw from a bowl to win a prize within a range of monetary values.
Other determinants to draw for a prize could be perfect attendance or a high level of participation.
Is Contingency Management Effective?
It is fair to ask whether this rewards-based treatment model is effective at helping people achieve long-term sobriety.
It is important to keep in mind that most treatment centers for drug and alcohol abuse do not use just one form of therapy for treatment but a combination of therapies.
In conjunction with other treatment methods, CM has, in fact, been shown to be effective for treating certain substance use disorders
Contingency Management For Stimulant Use Disorder
Contingency management is often used to treat stimulant use disorders like cocaine addiction.
For years, research has shown that people who are addicted to cocaine often have low self-esteem and a myriad of related confidence issues.
CM has been shown to be an effective form of treatment because it can bolster the client’s self-confidence by rewarding them for positive choices.
You can think of it as an antithetical approach to addiction that rewards negative behavior.
Contingency Management For Other Substances
CM can also be used to treat other substance use disorders.
Those substances include:
In recent years, CM has begun to be used to treat opioid use disorder. This includes the use of CM with clients who are on a methadone maintenance program.
Concerns About Contingency Management
The use of rewards to create positive behavior patterns has been studied and well-documented, but concerns have been raised about the effects of certain applications of CM.
People In Treatment Could Use Money For Drugs
Giving money to people in treatment raises concerns that money may create a temptation to relapse. Critics argue that even vouchers or prizes can be “flipped” for cash.
Prize Incentives And Gambling Addiction
Some practitioners in the addiction treatment field have raised concerns about the drawing or raffle approach to contingency management saying it could unintentionally promote gambling.
Gambling addiction is a relatively common co-occurring disorder, so the fear is that one addiction will essentially replace the other.
Best Practices For Contingency Management
Best practices for contingency management include having a predetermined system for controlling how clients receive rewards.
Using a star or points chart is one way to organize the reward system. When clients receive a certain number of points, they can exchange those points for a reward.
The use of vouchers for positive behavior is probably the safest and least problematic form of reward for positive choices and attaining sobriety.
Find Treatment Today
If you are battling choices that lead to continued addiction, you can find substance abuse treatment today. Call DetoxRehabs.net to learn more about your choices for treatment.Article Sources
- AP News
- Fox News
- Harm Reduction Journal
- National Institute on Drug Abuse (NIDA)
- Office of the Mayor
- Texas Institute of Behavioral Research at Texas Christian University
- The Psychiatrist
- The Washington Post