RomaFitzmaurice

For example, the punchbowl method rewards negative screens for drug use with the opportunity to draw a prize from a “punchbowl.” Most prizes have low monetary value (e.g., $1), but the inclusion of rarer large prizes (e.g., $50) both saves money while offering a successful inducement for abstinence. Over time, these positive (e.g., enhancing social experiences) and negative (e.g., reducing negative affect) reinforcing effects become associated with a wide variety of both internal and external stimuli. Although CBT for substance abuse is characterized by heterogeneous treatment elements-such as operant learning strategies, cognitive and motivational elements, and skills building interventions-across protocols several core elements emerge that focus on overcoming the powerfully reinforcing effects of psychoactive substances. Meta-analytic reviews indicate that effect sizes for the efficacy of CM across studies are in the moderate range, with greater efficacy for some substances (opioids, cocaine) relative to others (tobacco, polydrug use). Larger treatment effect sizes were found for treatment of cannabis, followed by treatments for cocaine, opioids, and, with the smallest effect sizes, poly-substance dependence. A meta-analytic review of interventions based on MI found effect sizes across studies in the small to moderate range for alcohol and the moderate range for drug use when compared to a placebo or no-treatment control group, and similar efficacy to active treatment comparisons.

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