Why reward people for staying sober?

Rewards can be a powerful tool to help people stay engaged with their recovery.

There have been over 170 scientific studies on using money or gift cards to reward people with alcohol or drug problems for staying sober and staying in treatment. It’s called “Contingency Management,” because it manages the disease of addiction using rewards that are contingent on healthy behavior. It’s one of the most well-studied techniques we have to improve outcomes in addiction treatment. Contingency Management is recommended by the U.S. Surgeon General, the National Institutes of Health, and the American Society of Addiction Medicine.

Rewards change behavior through reinforcement.

Reinforcement is a simple concept: figure out which behaviors lead to feeling good, and do those; figure out which behaviors lead to feeling bad, and stop those! Good consequences reinforce behaviors. It’s something that brains (not just the human brain but also animal brains) are very good at, and have been doing for millions of years. Our brains do lots of other things, including much more complex forms of learning, too. But reinforcement can be a very powerful drive.

Addiction is one example of reinforcement. Using substances feels good, at least in the short term, and stopping substance use can cause withdrawal, which feels bad. Your brain learns to connect the substance with the immediate highs and lows, which reinforces the substance use until it becomes an addiction. Reinforcement doesn’t work through thinking about rewards – it’s more like a reflex or automatic reaction. And it can be very hard to overcome a brain system that works automatically and not by conscious thinking.

Since drugs and alcohol have led to our brain wanting instant gratification (pleasure) for getting high, rewards can help by leading our brains to wanting instant gratification for getting healthy. Rewards can teach the unconscious part of the brain that there are positive consequences to staying sober and negative consequences of using, using the language it understands -- short-term consequences.

However, don’t be fooled into thinking that rewards are enough to keep people sober -- they’re not. We also have a conscious part of the brain which needs to learn recovery skills, using the language of therapy, counseling, and coaching. Rewards are helpful in getting someone on track, but they’re a partner to treatment, not a substitute for it. In the long run, it’s up to each individual to work on their treatment, and to continue to stick with recovery after the rewards end.