Contingency Management Example 3 of 4: Mobile Device with Live Recovery Coaching

Disclaimer: nothing in this post should be taken or held as clinical instruction, clinical supervision, or advisory concerning patient care.

At my workplace in the early 2000’s we were early adopters in various kinds of technology and clinical practices that were beyond “evidence-based”. We aimed for best practice, promising practices, and those that were really cutting edge.

One of those practices was providing our SUD patients (mainly people with chronic and severe co-occurring SUD and MH disorders) early versions of mobile phones (flip phones back then). This included an assigned recovery coach who they could call or would call them. We would use basic life history information from clinical screening interviews to help guide when to call, etc.

After this was implemented, we noticed that the utilization of the system was far below what we expected. When we asked individual patients for feedback on why this wasn’t being used, and focus-grouped the lack of utilization of this system, the information we obtained was interesting. The great majority of people had pawned their cell phones, and the most common explanation many told us was that they used that money to buy crack cocaine.

This reminded me that a primary reinforcer (like food) is almost always less popular than a conditioned reinforcer (like money). This is based on the behavioral principle that a conditioned reinforcer can be used to obtain other reinforcers. We also learned that the coaching and phones didn’t have the intrinsic value for many of the patients that we imagined they would.

Based on this practical experience, do we deduce that paying people cash money to use less would be a great way to implement CM in SUD services?

Lessons learned by our administration from this example of implementing CM included:

The person served decides what is rewarding. The clinician or researcher might think they know what the person will like, but the person served ultimately decides.
The person, their clinical care, recovery support, and CM activities must be understood in context of the person’s life and life situation.

The next post in this series will describe the innovative development of a specialized suboxone-based Intensive Outpatient Program for those with DSM-IV opioid dependence.

In case you missed it, here is example # 2.