Contingency management for cocaine treatment: cash vs. vouchers

Abstract

The efficacy of contingency management (CM) for treating drug abuse is well supported. The most widely used form of CM is voucher-based reinforcement therapy (VBRT), where clients receive an escalating schedule of vouchers that can be redeemed for goods and services for meeting treatment goals. Though generally rejected due to concerns about potential harms to drug using participants, research suggests that cash may be a more effective reinforcer. This three-group randomized trial compared the efficacy of cash-based reinforcement therapy (CBRT) to VBRT and a non-CM condition on cocaine abstinence and treatment attendance; and examined whether CBRT resulted in greater levels of harm than VBRT. Findings indicated that the CBRT was as effective as VBRT when compared to the non-CM condition and that it did not increase rates of drug use, cravings, or high-risk behaviors. Future research should examine potential cost savings associated with a cash-based CM approach as this could have important implications for the wider adoption of the CM model.

Keywords: Cash-based reinforcement; Cocaine; Contingency management; Substance abuse treatment; Voucher-based reinforcement therapy.