Treatments for substance misuse

1. Treatments for substance misuse Token economy programmes

2. Known as ‘contingency management’ when used with substance misusers

3. A token economy programme involves a system of rewards being set up for desired behaviour, sometimes with punishments to discourage behaviour which is undesirable • Rewards are usually tokens or points, and these can be periodically exchanged for something that the individual wants • This is an important part of the programme, as the rewards must genuinely reward the person

4. Desirable behaviour such as co-operation and compliance is reinforced with the use of tokens • These tokens have no intrinsic value and are called secondary reinforcers • They can however be exchanged for primary reinforcers which are things that are wanted by the person

5. It is very important that there are clear definitions of: • what is a desired behaviour • what is a token • how tokens are allocated • what is a reward • how there will be gradual changing of the giving of tokens to shape the behaviour • how many tokens there are for each reward • how the reward will be removed once the behaviour is achieved

6. TEPs are mainly used in residential treatment settings, where staff can closely monitor and regulate the programme

7. Generalisation - when a behaviour learned in one situation is transferred to another, or when learning of one behaviour is transferred to a similar behaviour; this is important when talking about token economies • The idea is that desired behaviour, once reinforced and established in one setting (the therapeutic situation), would be generalised to outside the setting, so that appropriate behaviour would be established in the individual’s everyday life

8. Task ... • Imagine you are implementing a token economy programme for a substance misuser • On your tables, come up with 5 behaviours that you would like to be followed, the rewards you will use (i.e. how many tokens are needed, what will the tokens be swapped with), and any punishments that can be used if behaviours aren’t followed. • You can present your token economy programme in any form you wish – you can act it out by using role-play, you can produce a poster, you can write them on the board, or simply explain it to the class

9. Evaluation ... • Learning may not transfer to the individuals’ home and social environment, which means that they may relapse; rewards which have meaning in the therapeutic setting may have no meaning outside of it • Programmes have to be carefully planned and controlled, involving multi-disciplinary teams; problems can occur (e.g. lack of consistency from stafffrom different areas)

10. Evaluation ... Can be administered by anyone (with training) and tokens and rewards are relatively cheap, so programmes are generally cost effective Clear rules mean staff know when to award a token, so the programme is relatively easy to administer

11. So are TEPs an effective treatment for substance misuse? • Eriksson et al’s research supports the effectiveness of TEPs as a treatment for substance misuse; they found that participants on the programme reduced their drug use significantly while on the programme • Sindelar et al (2007) compared groups of heroin users - all were getting the standard daily treatment with methadone but half were also on TEPs; those on the programme were far more likely to test negative for heroin use