Mobile Technology Could Unleash Power of Reward-Based Treatment

Incentive-based “contingency management” strategies remain largely underutilized in substance use treatment, despite their significant basis of support in research. A new report suggests that the wide availability of mobile technology could assist in bringing contingency management to its full potential for addiction treatment.

The lead author of a report published online in Perspectives on Behavior Science tells Addiction Professional that systems available through Internet connection could unleash the effectiveness of contingency management, in part by eliminating barriers related to identifying a facility-based program that offers incentives for progress in treatment.

Also, “Automation can help deliver treatment with fidelity” to standards of practice, says Jesse Dallery, PhD, a researcher in the Department of Psychology at the University of Florida.

Dallery and colleagues from other institutions, including Dartmouth College and Rowan University, have authored the report “Technology-Based Contingency Management in the Treatment of Substance Use Disorders.” It is scheduled for print publication in the Association of Behavioral Analysis International's journal this fall. The report describes the main features of technology-based contingency management as a monitoring procedure for detecting substance use, a delivery procedure for the rewards used, and an authentication process that can confirm the user's identity remotely.

“Technology-based methods also allow arranging group contingencies that harness online communities, and they permit targeting multiple health-risk behaviors with a combination of sensor-based technologies,” the report's abstract states.

Widely used in smoking

Dallery, who has been involved in research into technology-based contingency management since the early 2000s, says smoking cessation remains the most common drug target for this approach so far. Some strides also have been made in technology-based systems targeting alcohol use, such as with those employing Breathalyzer-type technology in which facial recognition is used to verify the end-user's identity.

“We need more research on long-term outcomes of technology-based contingency management,” Dallery says.

He says there is considerable overlap in the specific rewards used in facility- and technology-based contingency management systems. In general, financial rewards for meeting goals in treatment are most common, followed by graduated prize-based incentives that have been used most frequently in alcohol treatment settings, he says.

Barriers remain

It can be difficult in many communities to identify treatment facilities that incorporate contingency management, and Dallery believes this can be explained in part by lingering misperceptions about reward-based systems.

“Programs may think it is more important for patients to develop their own reasons [for recovery], and may think that this will get in the way of something more rich,” he says. Yet he believes that every individual must find something that will compete at the outset against the immediacy of drug reinforcement. “Then you can work on the longer-term issue,” he says. In that respect, contingency management can be highly compatible with numerous treatment approaches, including 12-Step approaches, as a complementary strategy.