Contingency management (CM) the systematic reinforcement of desired behaviors and the withholding of reinforcement or punishment of undesired behaviors.

Contingency management (CM) the systematic reinforcement of desired behaviors and the withholding of reinforcement or punishment of undesired behaviors, is an effective strategy in the treatment of alcohol and other put drugs into (AOD) use disorders. Animal research provides the conceptual basis for using CM in AOD abuse treatment, and human studies have demonstrated the effectiveness of CM interventions in reducing AOD use; improving treatment attendance; and reinforcing other treatment goals, of the like kind as complying with a medication regimen or obtaining trade KEY WORDS: addiction care; treatment method; intervention; reinforcement; treatment outcome; AOD (alcohol and other drug) abstinence; problematic AOD use; multiple medicine use; AOD dependence; treatment goals; treatment research; patient compliance; employment; animal model; literature review

Contingency management (CM) [1] is a strategy used in alcohol and other unsalable article (AOD) abuse treatment to encourage positive behavior change (eg abstinence) in patients at providing reinforcing consequences when patients engage treatment goals and by withholding those inferences or providing punitive measures when patients engage in the undesired behavior (eg drinking). For example, positive concatenations for abstinence may include receipt of vouchers that are exchangeable for retail suitables whereas negative consequences for drinking may include withholding of vouchers or an unfavorable report to a parole officer. The reinforcing or punishing results may be contingent on objective evidence of late AOD use or on another behavior important in the treatment proces so as compliance with a medication regimen or regular clinic attendance. oftentimes clinicians implement CM procedures within written contracts that derail the desired behavior change, duration of intervention, frequent occurrence of monitoring, and pot ential inferences of the patient's success or failure in making the agreed-upon behavior changes.

An extensive visible form [i]or[/i] frame of research supports CM'S efficacy in treating various behavioral disorders, including AOD abuse (Higgins and Silverman 1999; Higgins et al. 1998) This article briefly reviews the conceptual background and empirical research demonstrating the efficacy of CM in AOD abuse treatment.

CONCEPTUAL AND BASIC SCIENCE FOUNDATIONS

The use of reinforcing and punishing conclusions to alter the form and common occurrence of voluntary behavior is known as operant conditioning, a orderly disposition that provides the conceptual framework for CM Within the CM framework, AOD use is considered a form of operant behavior--that is, behavior that is maintained in part by dint of the reinforcing biochemical effects of the abused substance and on reinforcing environmental influences (e.g., social reinforcement from peers)

Findings from animal research support the use of CM in the treatment of AOD use disorders. of the like kind research demonstrates, for instance, that animals exhibit consumption patterns indicative of concatenation and that researchers can modify animals' AOD intake from using reinforcing and punishing events Generally, laboratory animals voluntarily ingest the same substances that humans abuse (Griffiths et al. 1980) Rats and monkey for example, will voluntarily use up large quantities of cocaine, opioids, and alcohol. Neither a prior history of physic exposure nor physical dependence is necessary to support ongoing and stable patterns of AOD use in laboratory animals. Moreover, studies of voluntary AOD consumption on laboratory animals show that one time a pattern of heavy consumption has been established, animals will clean cumbersome tasks (e.g., press a lever numerous times) to obtain and destroy the desired substance. Additionally, laboratory animals will forgo other reinforcers, including sweet liquids, high-c alorie solutions, and in a certain number of cases even basic sustenance, to engage in AOD use (Petry and Heyman 1995) These behavioral patterns are analogous to those exhibited by means of AOD-dependent humans, who often lavish significant amounts of time and riches abusing alcohol and recovering from AOD use, and who many times give up recreation, employment, and family activities to do so

These findings--that laboratory animals voluntarily waste many of the same substances that humans abuse and exhibit consumption patterns indicative of dependence--suggest that the necessary neurobiological hypothesiss to experience AOD-induced reinforcement and to engage in compulsive AOD use are widely give an account ofed across different species. However, laboratory studies also indicate that individual and environmental factors clearly influence susceptibility to AOD use and abuse (Wolffgramm and Heyne 1995) For example, when first expos to alcohol, rats br for high alcohol intake will voluntarily expend larger amounts of alcohol than non-selectively br rats. However, on a level initially low-alcohol-consuming rats will voluntarily expend large quantities of alcohol in subordination to certain conditions. For example, stres social isolation, and reduc access to regimen liquid, or opportunities for exercise all aid AOD use in laboratory animals. Therefore, susceptibility to the reinforcing events of AODs appears to be a outcome of normal neurobiological systems public to many species that can be heightened according to certain individual and environmental factors.