skip to main content

Contingency Management Cocaine — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateSubstance MisuseContingency Management CocaineMRCPsych Paper B

A 34-year-old man with cocaine dependence attends a specialist drug treatment service and wishes to achieve abstinence. He has no comorbid depressive or anxiety disorder and does not have a non-drug-misusing partner in close contact. Which formal psychosocial intervention is most specifically recommended to reduce his cocaine use and promote abstinence?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Contingency management linked to drug-negative samples

Contingency management is the best answer. NICE recommends it for people who primarily misuse stimulants, including cocaine, to reduce illicit use and promote abstinence. It uses timely, consistent positive reinforcement—commonly vouchers or privileges—contingent on agreed behaviours such as providing cocaine-negative biological samples. Drug-focused CBT and psychodynamic therapy should not be offered routinely for stimulant misuse, although CBT may treat comorbid depression or anxiety. Brief motivational interventions are principally recommended when concerns are identified in people with limited or no contact with drug services, rather than as the definitive formal treatment here. Behavioural couples therapy can be considered when the person is in close contact with a non-drug-misusing partner, which is explicitly absent in this case.

Reference: National Institute for Health and Care Excellence. Drug misuse in over 16s: psychosocial interventions (CG51), sections 1.4.1 and 1.4.6. 2007, last reviewed 2016. https://www.nice.org.uk/guidance/CG51/chapter/recommendations