Contingency management

Contingency management (CM) is the application of the three-term contingency (or operant conditioning), which uses stimulus control and consequences to change behavior. CM originally derived from the science of applied behavior analysis (ABA), but it is sometimes implemented from a cognitive-behavior therapy (CBT) framework as well (such as in dialectical behavior therapy, or DBT). Incentive-based contingency management is well-established when used as a clinical behavior analysis (CBA) treatment for substance use disorders, which entails that patients' earn money (vouchers) or other incentives (i.e., prizes) as a reward to reinforce drug abstinence (and, less often, punishment if they fail to adhere to program rules and regulations or their treatment plan). Another popular approach based on CM for alcoholism is the community reinforcement approach and family training (CRAFT) model, which uses self-management and shaping techniques. By most evaluations, its procedures produce one of the largest effect sizes out of all mental health and educational interventions. One form of contingency management is the token economy system. Token systems can be used in an individual or group format. Token systems are successful with a diverse array of populations including those suffering from addiction, those with special needs, and those experiencing delinquency. However, recent research questions the use of token systems with very young children. The exception to the last would be the treatment of stuttering. The goal of such systems is to gradually thin out and to help the person begin to access the natural community of reinforcement (the reinforcement typically received in the world for performing the behavior). Walker (1990) presents an overview of token systems and combining such procedures with other interventions in the classroom. He relates the comprehensiveness of token systems to the child's level of difficulty. Another form of contingency management is voucher programs.