Speaking of Psychology Incentivizing recovery: Why contingency management works to treat addiction, with Lara Coughlin, PhD, and Michael McDonell, PhD
Mar 4, 2026
Lara Coughlin, PhD, licensed clinical psychologist researching contingency management for stimulants, alcohol, and tobacco. Michael McDonell, PhD, psychologist studying contingency management and implementation in rural and clinical settings. They explain contingency management’s reward-based principles, why small immediate incentives shift choices, how it’s used for stimulants, alcohol, tobacco and opioids, and challenges to scaling it in real-world systems.
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Contingency Management Is Operant Conditioning In Practice
- Contingency management uses operant conditioning: immediate tangible rewards reinforce objective behaviors like drug-negative urine tests.
- Rewards need immediacy and measurable outcomes to counter powerful drug reinforcement, e.g., $10 given the same day of a negative test.
Immediacy Makes Small Rewards Powerful
- Immediacy of small rewards is critical: a modest $10 today can outweigh distant benefits and deter immediate drug use.
- This links to behavioral economics: immediate tangible incentives shift choices away from potent, immediate drug rewards.
Cocaine Versus Cash Laboratory Choice
- Lab study offered a line of cocaine versus small cash and showed choices flip as money increased from $0.05 to $2.00.
- At ~$2 in 1990 dollars most participants chose cash over cocaine, demonstrating small incentives' potency.