Contingent reinforcement

Higgins ST, Wong CJ, Badger GJ, et al Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up. J Consult Clin Psychol 68 64-72, 2000... 

Stitzer ML, Bigelow GE, Liebson lA Hawthorne JW (1982). Contingent reinforcement for benzodiazepine-free urines evaluation of a drug abuse treatment intervention. Journal of Applied Behavioural Analysis, 15, 493-503... 

Structured contingency reinforcement programs, including community reinforcement, are promising nonpharmacological treatments of illicit drug use disorders. Conjoint therapies also seem to be effective. 

Many of the classic approaches to leadership concentrated on how to maintain or achieve results as expected or contracted between the leader and the employees. These transactional theories and practices viewed leadership in terms of contingent reinforcement, that is, as an exchange process in which employees are rewarded or avoid punishment for enhancing the accompUshment of agreed-upon objectives. 

With all of these pharmacotherapies, concurrent behavioral treatment is critical to retain the patient in treatment and maintain adherence to medication treatment. Contingency management programs in which patients receive vouchers that can be used to purchase pro-social goods and services are the most common reinforcer approaches used to initiate and maintain stimulant-free urine test results (Anker and Crowley 1982 Boudin 1972 Higgins et al. 1991, 1993, 1994). The major problem with these approaches has been maintaining abstinence after the reinforcers are withdrawn completely and devel-... 

A number of psychosocial treatments for alcohol and other substance use disorders exist and are widely used. In this chapter, we discuss six of these psychotherapies as they are applied to alcohol, cocaine, and opioid dependence brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral treatments (including contingency management and community reinforcement approaches), behavioral marital therapy, and 12-step facilitation. We also describe studies that examined the efficacy of a medication in combination with one or more of the six psychotherapies. In the second section of the chapter, we highlight research that directly studied the interaction between psychosocial and pharmacological treatments. 

Studies have shown that CM can be used to directly reinforce adherence to medication treatments as well (Petty 2000). Liebson et al (1978) found that methadone-maintained alcohol-dependent patients reduced alcohol use when methadone treatment was contingent on disulfiram consumption. To date, one of the most common applications of CM techniques to pharmacotherapy has been the provision of vouchers or cash contingent upon naltrexone consumption in recently detoxified opioid-dependent patients (Carroll et al. 2001, 2002 Preston et al. 1999). These studies have generally reported significant increases in retention and reductions in opioid use among patients receiving the CM treatment, relative to other therapies. 

Schottenfeld RS, Chawarski MC, Pakes JR, et al Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. Am J Psychiatry 162 340-349, 2003 Smith JE, Meyers RJ, Delaney HD Community reinforcement approach with homeless alcohol-dependent individuals. J Consult Clin Psychol 66 341-348, 1998... 

Training and testing sessions were conducted in 10 identical isolated Col bourn operant chambers equipped with two levers mounted on either side of a motor-driven dipper. Reinforcement consisted of 3-second presentations of 0.2 ml Carnation Slender, a commercial liquid diet food, diluted 1 1 with water. Reinforcement contingencies and data recording were performed using a Rockwell AIM 65 microcomputer. 

While pharmacologic agents may help prevent relapse, psychotherapy should be the core therapeutic intervention. Motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), 12-step facilitation (TSF), behavioral couples therapy (BCT), community reinforcement approaches, and contingency management are the best-studied forms of psychotherapy in this group of patients. 

Atnip, G. 1977. "Stimulus and Response-Reinforcer Contingencies." In Autoshaping, Operant, Classical, and Omission Twining Procedures 28 59-69. 

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