Money Management as a Tool to Help Maintain Abstinence

What Is Contingency Management Therapy?

Money Management as a Tool to Help Maintain Abstinence

Contingency management may help with the substance use disorder treatment per clinician’s discretion.

Contingency management can be especially beneficial for individuals who are unable to take certain medications for managing addiction or for those who only have limited success using these treatments. Used with medications and/or other treatment therapies, contingency management may increase treatment retention rates and improve a client’s chance of sobriety and recovery success.

Contingency Management Rewards Healthy, Sober Living

Humans, by nature, are wired to pursue activities and behaviors that create a sense of reward. Reward, then, enforces these behaviors, encouraging a person to repeat it in the future. This is called positive reinforcement. This is largely why substance abuse becomes so attractive to a person once they abuse drugs or alcohol.

With healthy, natural rewards, such as wholesome food, water and nurturing, this reward system can be beneficial. However, in the case of substance abuse, activating this reward system can be devastating.

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Drugs and alcohol stimulate the reward and pleasure centers of the brain by producing a chemical neurotransmitter called dopamine. Dopamine is responsible for producing the trademark buzz, euphoria, high, rush or other pleasurable feelings many drugs create.

In order to recreate these effects, many people consume the drug again.

Eventually, as a tolerance occurs, the amount of drug needed to produce these feel-good effects climbs, circumstances which can push a person closer to addiction.

For a person in treatment, or in the beginning stages of recovery, the absence of a drug-induced reward can be intimidating. In fact, the longing for reward sensations is a major factor in relapse.

Part of treating addiction revolves around normalizing brain function as best as possible and teaching a person to find healthier ways to experience reward and pleasure. After an addictive lifestyle, it can be difficult for a person newly in recovery to experience a sense of reward or pleasure while sober. Contingency management can be a useful tool in fighting this state.

Through a system of positive incentives, a person is taught to appreciate non-substance-related rewards. Not only do these rewards encourage abstinence and healthy behaviors, but they also boost self-confidence, a much-needed change after the poor morale caused by addiction.

What Is A Contingency Management Program?

Contingency management is founded on operant conditioning, a concept that people learn and change based upon rewards and punishments for their behaviors. People respond positively to incentives, and in the case of substance abuse, this system of behavior modification has shown great success.

Contingency management uses rewards to reinforce behaviors that support both facility requirements and a person’s individual recovery and sober living goals.

Quite often these goals include negative urine tests or breathalyzer results, however, a program may also use incentives to reward treatment attendance or educational, social or vocational goals.

One study even found that contingency management incentives increased the number of high-risk injection drug abusers who completed hepatitis B vaccination programs.

In addition to being used in inpatient drug rehab programs, contingency management is frequently used in community-based treatment programs, including traditional outpatient, intensive outpatient, partial hospitalization and methadone maintenance programs. In this role, outpatient programs are generally best used as a step-down service from a residential treatment program.

What makes contingency management stand apart from other treatment approaches is the emphasis on positive reinforcement versus punishment.

Some treatment facilities foster a negative environment by using confrontational techniques when a person doesn’t adhere to program guidelines.

These procedures can alienate a person from the therapeutic community of treatment, break their self-confidence and reduce their motivation for change.

Instead, contingency management uses a more supportive form of negative consequences. Specifically, if a person fails to meet their goals or has a positive drug test they would not receive a voucher or prize. When compared to confrontational techniques or punishments, using rewards to support positive behaviors can have a more inspiring and lasting impact.

How Does Contingency Management Work?

Once individualized treatment goals are established and agreed upon, a written contract may be drawn up. This contract holds a person accountable and outlines the arrangements of the contingency management program.

Two forms of motivational incentives or rewards-based systems widely used in addiction treatment include:

Voucher-Based Reinforcement: In this method, participants receive a voucher for each drug-free urine sample or negative breathalyzer result.

Each voucher has a cash value that may then be used to obtain various goods, services and/or retail items that can be part of a balanced, sober life. Examples include clothing, electronics, food, movie passes and restaurant gift certificates.

As a person continues to have negative test results, the value of the vouchers increase.

The National Institute on Drug Abuse (NIDA) reports that this method is beneficial for individuals addicted to opioids and stimulants, with particular benefit for people with a cocaine use disorder.

Prize Incentives: It’s recommended that these programs last three months or more. In this time, at least once a week, clients draw from a “fishbowl” for a cash prize. Certain slips may offer words of encouragement only, while others have prizes ranging from a dollar to a hundred dollars or more.

According to the NIDA, research has shown that prize incentives do not encourage gambling behaviors in treatment participants.

Treatment providers may also offer extra privileges to clients as an additional way to reward healthy behaviors.

If there’s a missing or positive sample, positive reinforcement is typically withheld, an action that is sometimes referred to as a punishment. For instance, if a person has a positive urine sample they would not receive a slip or chip for a cash prize drawing. In the voucher system, should a person test positive, they would start over at the lowest voucher value.

Contingency Management And Integrated Care

many forms of treatment, especially other forms of behavioral therapy, an individual may have greater success when contingency management is coupled with other therapies.

While contingency management is effective, intensive psychotherapy sessions are often necessary to help a person overcome the root causes of addiction. This integrated approach typically includes additional behavioral therapies, such as cognitive-behavioral therapy.

Contingency management may be helpful for co-occurring disorder treatment when a person has both a mental health and substance use disorder.

If you or a loved one needs help for substance use, stop waiting. At Vertava Health Texas, formerly The Treehouse Rehab, we are here to help. Reach out to us today.


The Best Personal Finance Services for 2021

Money Management as a Tool to Help Maintain Abstinence

We're a year and a half into the COVID-19 pandemic, and tens of thousands of Americans are still struggling with the hit to their personal finances. So, it’s important to know where you stand with your money, whether or not you’ve been affected so far. After all, no one can accurately predict where we’ll be in a month, six months, or a year.

More than ever, you need to keep a close eye on your income, expenses, budget, and investments. There are many websites and desktop apps that help you understand your personal finances so you can make better, more informed decisions about spending. Many are free, and the rest are reasonably affordable. We review 11 of the best here. 

Critical Connections

All the applications we reviewed have new features, but they share common characteristics. For example, most of them support online connections to your financial institutions.

That is, you can download cleared transactions and other account data from your banks, credit card providers, brokerages, and other financial institutions, and see all of it neatly displayed in the applications' registers.

Typically, you simply enter your login credentials for those financial sites, though occasionally you have to provide additional security information.

Once you import a batch of transactions, you will probably spend some time cleaning up the data. For example, transactions need to be correctly categorized as income (salary, freelance payment, and interest, for example) and expenses (food, mortgage, utilities, and so on).

Most personal finance apps guess the appropriate categories, but you can always change it—and you can split transactions among different categories. If you're conscientious about this, you'll see charts and reports that accurately tell you where you're earning and spending your money.

This information can also be helpful when tax preparation time rolls around.

Depending on the service, you might be able to add transaction tags. That way, you can search for transactions that are related in ways other than category assignments. You can add notes and attach files, too.

If you bought something with cash, though, your bank won't have a record of it. In those circumstances, you can manually create a transaction. CountAbout and others go a step further, providing additional tools that let you designate selected transactions as recurring, for example.

Moneydance, too, is good at transaction management, but Quicken Deluxe tops all rivals.

Quicken's dashboard lets you see your income and expenses.

A Different Kind of Dashboard

Every service reviewed here has a dashboard, or home page, that you see when you first log in. Sometimes, the dashboard is the only screen you need to see, because it displays the most pertinent information about your financial situation, such as your account balances and pending bills.

You see charts and graphs that tell you, for example, what your income is versus your spending, and how you're doing on your budget. You may be able to set goals and gauge your progress at meeting them, as well as see live updates on your investment portfolio if markets are open.

Basically, this overview shows you snippets and highlights of the data analysis these services do behind the scenes (with options to dive deeper). Click a checking account balance in Mint, for example, to go to the account's register.

Click your credit score in Credit Karma to learn what contributes to it and how it's recently changed.

In short, a personal finance app's dashboard can either provide a quick look at your money situation or serve as a springboard to a deeper financial study.

Budgets, Goals, and Bills

Being conscientious about your finances includes minimizing your expenses, so that they come in below your income.

That’s the philosophy that the developers behind Personal Capital have: Spend less than you earn every month. Having a realistic, detailed budget helps.

Budgeting tools in personal finance applications range from very simple (Personal Capital) to exceedingly complex (You Need a Budget, or YNAB).

The mechanics of creating a workable budget are much easier than the process of specifying your limits. It’s often guesswork until you’ve been working with a budget for several months and start to see how your money comes and goes. For that reason, Quicken Deluxe and some other personal finance apps let you use past income and expenses as a model.

Mint treats each category as a budget. You select one, choose a frequency (for example, every month), and enter an amount.

The site shows you how well you're adhering to each budget by displaying a series of colored horizontal bars that show where your spending is currently compared with your budgeted amount.

Green means you're doing OK, and red means you've gone over your self-imposed limit. You can tweak each budget as you learn more about your spending habits by clicking up and down arrows.

Quicken Deluxe considers a budget to be a comprehensive table that contains all categories. The software also lets you view your budgets by a variety of time periods (monthly, annually, and so on). It also provides tools to help automate your data entry.

Setting goals, such as establishing an emergency fund, isn't rocket science.

You specify the amount you're trying to save, the target date for achieving it, and the application tells you how much you have to save every month to achieve it. Some sites do more.

NerdWallet, for example, lets you link your goals to the appropriate spending account, so your progress is automatically tracked.

Quicken Deluxe includes additional planning tools that help you accelerate debt reduction, plan for taxes, and establish a comprehensive lifetime financial plan. Personal Capital offers free planning tools on its website, but it also has a team of financial professionals that provide advanced planning services for a fee.

Of the applications we reviewed, only one offers online bill-paying tools as a part of its service: Moneydance. You can set up a connection to the bank where you have a checking account, and use the bank’s bill-pay tools through through the service.

Other applications let you at least record bills and bill payments, because those figure into your personal finance picture significantly. Mint and Quicken Deluxe are especially good at this.

You can set up automatic connections to online billers (Xcel Energy or Verizon, for example) or enter offline bills from suppliers who don’t offer bill pay on their websites, such as your gardener or your occasional tech support person.

The site alerts you when they're due to be paid and lets you record payments manually.

An excellent credit score is gold. Beyond helping you get approved for a credit card, mortgage, car loan, and so on, it helps minimize the interest rate you'll pay. So, it's important to know not only what it is at any given time, but also to understand how it gets calculated and what you can do to improve it.

Credit Karma, Credit Sesame, NerdWallet, and WalletHub, all free websites, meet these critical needs. Credit Karma is especially comprehensive and efficient, in this regard. It regularly pulls your score from two of the three major bureaus, and gives you access to your credit reports.

One of the ways you can improve your credit score is to use financial products—credit cards, mortgages—that have attractive interest rates and other benefits, making it easier for you to pay off debt as quickly as possible.

The four dedicated free websites we reviewed help pay for the services they provide by displaying occasionally intrusive ads for products that might appeal to you your credit profile. You can also browse marketplaces for additional candidates.

Mint uses a similar business model so the site can remain free.

Of course, frequently canceling credit cards and/or acquiring new, different ones affects your credit score. Still, it's good to learn about these suggested products so that when the time comes, you'll know the best options.

Mint's dashboard is packed with useful information.

You may only want to use a personal finance service for day-to-day income- and expense-management, budgeting, and goal setting.

That said, financial applications, such as Mint and Quicken Deluxe, let you track your assets, including homes, vehicles, and investment holdings.

If you keep your financial data updated, the applications maintain a running tally that, when combined with your debt, reflects your total net worth.

You probably don't need advanced tools when you're away from your desktop or laptop. Still, when you're out spending money, it's good to know how much you have available. The personal finance services that we reviewed offer both Android and iOS apps.

Most offer somewhat reduced functionality, but you can at least check your account balances, view and add transactions, and see graphs illustrating numbers related to spending and cash flow. You may also be able to get your credit score and check the status of pending bills.

Moneydance is an exception; its mobile apps are not as mature as the competitions' apps.

Are all the reviewed applications easy to use? The short answer is yes. Credit Karma and Mint are the most user friendly, incorporating state-of-the-art interfaces with can't-miss navigation tools.

NerdWallet blends editorial content with a credit score, plus limited income- and expense-tracking tools. These dual purposes make the site somewhat confusing until you understand how the two co-exist.

CountAbout and Moneydance are certainly easy enough to use, but they have dated user interfaces. Quicken Deluxe has been around for so long and offers so much that its user experience is a little uneven. Its blend of old and new content can be a little jarring when compared with a solution built from the ground up to live online. YNAB takes some study to understand and use it effectively.

Each of these personal finance solutions offer something the others don't. That said, their skill at delivering the tools consumers need, and the cost at which they offer them, varies. Mint has won our Editors' Choice award for free personal finance services, and does so again.

Quicken Deluxe, on the other hand, is our Editors' Choice pick for paid personal finance services. We'd send people first to Mint if they're considering online personal finance, because of its usability, thorough tool selection, and useful feedback. And, of course, it's free.

Free is good in these days of economic uncertainty.


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