Contingency management (CM) is a type of treatment used in the substance abuse field. Patients' behaviors are rewarded for adherence to a treatment plan. As an approach to treatment, contingency management emerged from the behavior therapy traditions in mental health. By most evaluations, contingency management procedures produce one of the largest effect sizes out of all mental health and educational interventions.

The purpose of this study is to perform a randomized, controlled trial to evaluate the ability of a culturally-tailored contingency management (CM) intervention to increase alcohol and drug abstinence among American Indian (AI) tribal members from two rural reservations in the Northwest.

Inclusion Criteria:

1. Self-identify race as American Indian (AI)
2. Are seeking alcohol dependence and drug abuse treatment at a participating reservation
3. Are age 18 or older
4. Meet criteria of DSM-IV diagnosis of current alcohol dependence
5. Current drug misuse
6. Are not pregnant or planning to become pregnant for the duration of the study
7. Are English speaking
8. Have the ability to provide written informed consent

Exclusion Criteria:

1. Have significant risk of dangerous alcohol withdrawal, defined as a history of alcohol detoxification or seizure during the last 12 months AND expression of concern by the patient and/or healthcare provider
2. Meet criteria for DSM-IV diagnosis of drug dependence
3. Have significant risk of dangerous drug withdrawal and/or self-reported or medically documented severe withdrawal from drugs in the last 6 months
4. Have any medical or psychiatric condition, such as organic brain disorder, dementia, or psychotic disorder, that the Principal Investigator determines would compromise safe study participation
5. Are receiving drugs under the direction of a physician for pain management or another medical condition for which drug abstinence is contraindicated