Is addiction a choice? Contingency Management as treatment option

An opinion piece weighing in on the debate of substance abuse as choice, and the role of Contingency Management in the treatment of addiction.

minute read

Here, we take a look at a recent study highlighted in the New York Times that has brought attention and controversy to the idea that addiction is a choice. More on the theory of how behavior guides choices here, with a section at the end for your questions, comments, or feedback.

New Substance Abuse Treatment Theory Recognizes Basic Behaviors

Columbia University Associate Professor of Psychology, Carl L. Hart, recently discussed his new research on addiction and basic behaviors in the New York Times. According to Hart:

  • The wrong question about substance abuse treatment is: Is addiction a disease?
  • The right question is: How do we best treat drug addiction?

For Hart, choosing to use drugs such as crack or methamphetamines may more be related to not having other opportunities for alternative recreation or pleasure, and this is very significantly seen in lower economic classes.

While drug use rates are similar across classes,” states Hart, “addiction – like most other illnesses – is not an equal-opportunity disorder.”

New Substance Abuse Treatment Approach

Hart recommends that a new substance abuse treatment called Contingency Management. Why is Contingency Management used in substance abuse treatment? This idea originates in one of the basic assumptions of behavior. Here is a list of the most elemental assumptions in behaviorism.

  1. The only valid data in psychology is data based on behavior because behavior can be observed, and then objectively measured.
  2. Subjective data (such as introspection) is unreliable in understanding behavior because it is not objective.
  3. Learning is best understood in terms of external causes, and not internal ones.
  4. Mental activities are subjective, and, therefore, provide useless data.
  5. Behaviors are more heavily affected by the environment, and not heredity/genes; this means that behavior is learned.
  6. The building blocks of all behavior are simple stimuli or associates of stimulus-response.
  7. The laws of learning (behavior) are the same for all species and can be seen in any environment.

That is quite a shopping list. The principles that most interested Hart in relationship to addiction are the last two. “Our actions are governed to a large extent by what we are rewarded for in our environment,” explains Hart. “These cause-and-effect relationships where a reward is dependent (contingent) upon the person either doing or (in the case of drugs) not doing a particular behavior can be used to help changes all types of habits.”

The Contingency Theory of substance abuse treatment

The Contingency Theory of substance abuse treatment means helping a person choose something else over drugs that provide a higher reward. This may even be money, which was the reward used in Hart’s behavioral experiments with a group of individuals addicted to meth. There is particular sweet spot where the addicts made a rational choice and chose money over drugs. This experiment has provoked many comments, both positive and negative. In fact, check out the article and see the wide range of comments.

Regardless of whether you come down on the side of hogwash or holistic, Contingency Management interventions for addictions are a new and creative approach to helping those with addictions. More and wider research needs to take place. Ultimately, since effective treatment must be customized for each person, this new basic-behaviors approach may be a helpful addition to some, but not all, care plans.

About the author
Tracy Smith covers topics within the drug addiction niche being a recovering addict herself. She is thankful to have found treatment for her substance abuse that helped her become sober.
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