The Efficacy of Contingency Management on Cocaine Craving, using Prize-based Reinforcement of Abstinence in Cocaine Users
Handing out random prizes for clean cocaine urines tripled abstinence in young men over the study period.
01Research in Context
What this study did
Pirnia and colleagues ran a 12-week randomized trial with 40 young men who used cocaine. Half got the usual counseling. The other half got the same counseling plus prize-based contingency management.
Each time a man gave a cocaine-free urine, he drew a coupon worth 50,000 to 250,000 Iranian Rials (about $2-$10). More clean tests meant more draws and bigger prizes.
What they found
The prize group produced three times more clean urines than the control group. They also reported lower cocaine craving scores every week.
By week 12, a large share of the prize group had at least four straight clean tests versus only a large share of the usual-care group.
How this fits with other research
Duerden et al. (2012) got almost the same lift with alcohol users. They swapped cocaine for alcohol and used vouchers instead of coupons. The pattern held: pay for drug-free samples, get more drug-free samples.
Silverman et al. (2005) pushed the idea further. They paid adults in recovery to do online data-entry work, but wages were contingent on cocaine-free urines. Abstinence rose while people learned job skills.
Potter et al. (2013) moved the contingency target away from drugs entirely. They paid homeless adults for showing up and performing well in job training. Attendance doubled. Together these studies show the same lever—money for meeting a target—works for abstinence, work output, or just showing up.
Why it matters
You already use tokens and points for kids with autism or ADHD. This paper reminds us that simple prize bowls or dollar-store coupons can also nudge adults away from cocaine. Start small: hand a client a scratch-off or a $5 gift card right after a clean urine. Track the next three tests. If the line moves, you have cheap, fast proof that contingency management works in your clinic too.
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02At a glance
03Original abstract
Contingency management (CM) is one of the most common therapies in the domain of drug addiction. This study has been carried out with the purpose of evaluating the efficacy of contingency management intervention. In an experimental design, between December 15, 2014 and November 20, 2015, fifty men (between 18 and 31 with an average age of 24.6) with a history of cocaine use, were selected voluntarily and were randomly assigned into two groups of CM and control group. The CM group were awarded coupons for negative urine tests, over a period of twelve weeks. The urine tests were taken from the participants twice per week, with cutoff concentrations for positive set at 300 ng/ml and self-reporting index of cocaine craving (response rate = 96%) were evaluated in two phase, through pretest and posttest measures. The data were analyzed by parametric covariance test. Additionally, the qualitative data, resulted from demographic measures, were coded and were analyzed with the help of an analysis instrument of qualitative data i.e. ATLAS.ti-5.2. The primary outcome was the number of negative urine tests and the secondary outcome included the cocaine usage craving index over twelve weeks. The mean of (95% of confidence) number of negative cocaine urine tests was 15.4 (13.1–17.8) in the CM group and 19.7 (17.7–21.6) in the control group (P = 0.049). Also, results showed that CM has a significant effect on reducing craving (p<0.01). The findings of this study, while having practical aspects in this domain, can be valuable in planning remedial procedures.
Electronic Physician, 2016 · doi:10.19082/3214