As with many forms of treatment, especially other forms of behavioral therapy, a person may be more successful when emergency management is combined with other therapies. Another form of emergency management is the voucher program. In voucher-based emergency management, patients receive vouchers that can be redeemed for retail items that depend on objectively proven abstinence from recent drug use or adherence to other behaviour change goals. This particular form of emergency management was introduced in the early 1990s as a treatment for cocaine addiction.   The approach is the most reliable method for producing cocaine abstinence in controlled clinical trials.   One form of emergency management is the system of symbolic economy.  Token systems can be used in an individual or group format.  Token systems are successful in a variety of populations, including those suffering from addiction, people with special needs and delinquency.  However, recent research questions the use of token systems in very young children.  The exception to the latter would be the treatment of stuttering.  The purpose of such systems is to gradually thin and help the person access the natural community of reinforcement (the reinforcement usually received in the world to carry out the behavior).
 Bickel WK, Amass L, Higgins ST et al. (1997), The effects of adding behavioral treatment to opioid detoxification with buprenorphine. J Consult Clin Psychol 65(5): 803-810. Emergency management is useful not only for improving retention in treatment and reducing drug use in samples seeking treatment for primary substance abuse, but also for dual diagnosis individuals where the rate of substance use disorders is disproportionately high. Several studies now highlight the effectiveness of emergency management in reducing cocaine and marijuana use in people with psychotic disorders.8 Exceptionally high smoking rates are observed in people with schizophrenia, and emergency management promises to reduce smoking in this group as well.9 Petry NM, Bickel WK, Tzanis E et al. (1998), A behavioral intervention for improving verbal behaviors of heroin addicts in a treatment clinic. J Appl Behav Anal 31 (2): 291-297. Any change in behavior in patients that can improve their chances of successful recovery is not “artificial.” Even if individuals only show up for a chance to win, they still choose to be there. If the behavior they are working on is presence, their decision to get there on time proves that incentive works. The premise behind CM is to systematically use these and other reinforcement procedures to change the behavior of addicts in a positive and supportive way (Petry, 2000).
For example, in many CM treatments, patients leave urine samples several times a week and receive explicit rewards for each sample that tests negative for drugs. These rewards often consist of vouchers that have a monetary basis and can be redeemed for retail goods and services such as restaurant gift certificates, clothing, sports equipment, movie tickets and electronic devices. Preston KL, Silverman K, Umbricht A et al. (1999), improve adherence to naltrexone treatment with emergency management. Drug alcohol depends on 54(2): 127-135. Other research shows that CD can be a powerful tool for teaching people that they are able to change their behavior if they are motivated enough. This applies to all aspects of life. Success in a task such as arriving on time can lead to success in more complex tasks. Motivational incentives can also help participants build confidence over time and counter feelings of shame or low self-esteem. Higgins ST, Budney AJ, Bickel WK et al. (1994), Incentives improve outcome in ampatient behavioral treatment of cocaine dependence. Erzgenpsychiatry 51 (7): 568-576.
One of the most important skills in providing CM is the ability to effectively communicate behavioral expectations and work with patients to ensure they clearly understand those expectations. According to the National Institutes of Health, “In a number of studies, people who have already received emergency management continue to benefit from it, even when tangible reinforcement is no longer available. The longest duration of abstinence achieved during treatment is a robust and consistent predictor of long-term abstinence. Incentive-based emergency management is well established when used as a clinical behaviour analysis (CBA) for substance use disorders, meaning patients earn money (coupons) or other incentives (i.e., prizes) as a reward for increasing abstinence from drugs (and less often punishment if they do not comply with program rules and regulations or their treatment plan). Another popular CD-based approach to alcoholism is the Community Building Approach and Family Training Model (CRAFT), which uses self-management and design techniques. According to a study published in the Journal of Dual Diagnosis, “patients with dual diagnosis who were involved in emergency management-based care were more than 50 percent more likely to participate in scheduled treatment sessions than patients who were not involved in emergency management-based care.” The majority of CD treatments for substance use disorders amplify positive changes without punishing unmet expectations. Rewarding a drug-free urine sample could be aimed at reducing consumption behavior, but could easily become a punishment in the context of addiction treatment – creating an unpleasant environment that takes a person out. .