Maintaining disulfiram ingestion among outpatient alcoholics: a security-deposit contingency contracting procedure

Disulfiram is frequently prescribed to alcoholic patients as a deterrent to drinking. Although ingestion of ethanol by a disulfiram patient quickly results in an intense dysphonc reaction, the drug is not generally credited with significant value in alcoholism treatment (Mottin, 1973). It is suggested that most alcoholics simply stop taking the medication (Gerrein et al., 1973). and review articles conclude that motivation for abstinence is the crucial variable involved in successful disulfiram treatment (Ditman, 1966: Mottin, 1973). Motivation may be a characteristic of environmental contingencies rather than of individuals. If so, environmental contingencies should permit one to design into a disulfiram treatment progrim the requisite motivation to achieve therapeutic success. Contingency management procedures supporting disulfiram ingestion reported to date (Liebson et al., 1973: Haynes, 1973) have been of the sort to be imposed upon difficult populations rather than offered to general treatment applicants. Contingency contracting may represent a technique for supporting disulfiram ingestion appropriate to the broader general population of voluntary alcoholism treatment applicants. Contingency contract treatment (Homme, 1969; Stuart, 1971) is a procedure in which client and therapist mutually agree to establish an incentive for the client to achieve a behavioral goal. Contingency contracts can be viewed as a form of self-control therapy, and have been applied in a wide variety of problem areas, including school problems (Homme, 1969: Cantrell, et al., 1969). delinquency (Stuart, 1971),weight control (Mann, 1972). smoking reduction (Elliott and Tighe, 1968: Winett, 1973), drug abuse (Boudin, 1972), and alcoholism (Miller, 1972). Frequently contingency contracting involves the client's posting of a financial security deposit to serve as his incentive for achieving the agreed-upon therapeutic goal (Tighe and Elliot, 1968). This security deposit can be earned back consequent upon achieving specific goals, or sacrificed consequent upon failure. Controlled studies by Mann (1972) and by Winett (1973) have demonstrated this security-deposit procedure to be effective in enhancing weight loss and smoking reduction, respectively. We report here on our experience with application of the security deposit contracting procedure to maintaining routine disulfiram ingestion among outpatients in an alcoholism treatment program.