Effectiveness of very low-cost contingency management in a community adolescent treatment program (original) (raw)
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Behavior and Social Issues, 2009
Contingency management prize reinforcement (CM-PR) is a highly successful intervention for drug or alcohol dependence that shows improved outcomes over standard methadone maintenance and counseling, and 12-step disease model outpatient counseling. CM-PR treatment for individuals with substance abuse problems is examined by applying criteria for choosing an intervention. CM-PR is applied to Codes of Ethics from professional organizations of behavior analysts, chemical dependency counselors, psychiatrists and addictionologists, psychologists, nurses, and social workers that are major providers of substance abuse treatment. Limitations of using CM-PR in community treatment are discussed.
Addiction, 2004
Aims This study evaluated the efficacy of a low-cost, prize reinforcement contingency management (CM) intervention for reducing cocaine use. Setting Community-based treatment centers. Participants and design Cocaine-abusing out-patients ( n = 120) were assigned randomly to one of three 12-week conditions: standard treatment, standard treatment plus CM with an expected maximum of 80ofreinforcementorstandardtreatmentplusCMwithanexpectedmaximumof80 of reinforcement or standard treatment plus CM with an expected maximum of 80ofreinforcementorstandardtreatmentplusCMwithanexpectedmaximumof240 of reinforcement. Intervention In the CM conditions, patients earned the opportunity to win prizes for submitting negative urine samples and completing goal-related activities. Measurements Drug use was measured at intake and throughout a 3-month treatment period. Findings Patients in the 240CMconditionachievedmoreabstinencethanpatientsinthestandardcondition.PatientswhoinitiatedtreatmentwithpositiveurinalysisresultsweremostresponsivetotheCMintervention,withthe240 CM condition achieved more abstinence than patients in the standard condition . Patients who initiated treatment with positive urinalysis results were most responsive to the CM intervention, with the 240CMconditionachievedmoreabstinencethanpatientsinthestandardcondition.PatientswhoinitiatedtreatmentwithpositiveurinalysisresultsweremostresponsivetotheCMintervention,withthe240 CM condition engendering the best effects in this subgroup. In contrast, patients who initiated treatment with negative urinalysis results generally remained abstinent during treatment, regardless of treatment assignment. On average, patients in the two CM conditions earned 36and36 and 36and68 in prizes. Conclusions This study suggests that prize reinforcement CM may be suitable for community-based settings, and beneficial effects may be magnitudedependent in more severe patients.
Improving contingency management programs for addiction
Addictive Behaviors, 2004
Contingency management interventions effectively reduce or eliminate some individuals' problem substance use. Typically, those who do not benefit never experience the reward or planned contingency available through the intervention because they never produce the behavior (often abstinence) on which the reward is contingent. With two analog studies, we examine whether the effectiveness contingency management interventions improves when contingencies are arranged in ways that improve the likelihood of all participants experiencing the available reward. Participants were smokers not planning to quit. In Study 1, smokers were paid $0, 1, 3, 10, or 30 each day for 5 days for delivery of breath carbon monoxide (CO) levels either V 4 ppm or below half the median of their baseline levels. Higher payment amounts and the easier target criterion resulted in a higher likelihood of participants meeting criterion. Once participants met the 4 ppm criterion, however, they often maintained this behavior even in the absence of payments for reduced breath CO levels. An ineffective contingency management system was made effective based on these results. Study 2 examined the effectiveness of percentile schedules at reducing breath CO levels. Percentile schedules shaped lower breath CO levels. The effectiveness of percentile schedules in shaping abstinence was tested in treatment seekers, and percentile schedules were found to be effective at shaping abstinence. D
Journal of Substance Abuse Treatment, 2022
Introduction: An increasing number of adolescents and emerging adults are entering treatment for drug use disorders in high-income countries. This fact points not only to a need to evaluate treatment outcomes related to drug use reduction, but also to evaluate other indicators of treatment success. The aim of this study was to examine treatment effects on predicting readmission to drug use treatment and being convicted for a criminal offence among youth. A second aim was to examine whether a psychiatric history had an impact on these outcomes. Methods: Participants were 460 youth aged 15-25 who took part in the YouthDAT, a randomized pragmatic clinical trial for outpatient drug use treatment. The trial compared four treatment conditions consisting of 12 sessions of a manualized treatment based on cognitive behavioral therapy and motivational interviewing. Condition one was the standard (only the manual); condition two consisted of standard treatment and contingency management (CM) (Vouchers); condition three included standard treatment, text reminders, and lowintensity aftercare (Reminders+LIA); and condition four combined the standard treatment, CM, text reminders, and low-intensity aftercare (Combined+LIA). The study linked participants to register data on psychiatric history, drug use treatment history, and criminal convictions. Results: Treatment conditions Reminders+LIA (aB = 0.42, p = .026) and Combined+LIA (aB = 0.69, p = .000) predicted longer time to readmission compared to standard treatment. The Vouchers condition predicted a lower risk for criminal convictions (aIRR = 0.26, p = .001). Half of the participants had a psychiatric history. The treatments with additional strategies were useful in delaying readmission and reducing convictions for these youth. The results remained significant in the adjusted models accounting for relevant participant characteristics. Conclusions: Additional treatment strategies in outpatient drug use treatment, such as CM, text reminders, and low-intensity aftercare, predicted delayed readmission to treatment and fewer legal problems. Mental health problems were common among youth. However, the treatments with additional strategies were effective with youth with a psychiatric history. Overall, while the additional strategies may be resource demanding for clinical settings, they support treatment success and may also help to decrease other public costs. Trial registration: ISRCTN registry ISRCTN27473213.
Experimental and Clinical Psychopharmacology, 2007
Goods-based contingency management interventions (e.g., those using vouchers or prizes as incentives) have demonstrated efficacy in reducing cocaine use, but cost has limited dissemination to community clinics. Recent research suggests that development of a cash-based contingency management approach may improve treatment outcomes while reducing operational costs of the intervention. However, the clinical safety of providing cash-based incentives to substance abusers has been a concern. The present 16-week study compared the effects of goods-based versus cashbased incentives worth 0,0, 0,25, 50,and50, and 50,and100 on short-term cocaine abstinence in a small sample of cocaine-dependent methadone patients (N=12). A within-subject design was used; a 9-day washout period separated each of 8 incentive conditions. Higher magnitude ($50 and 100)cashbasedincentives(checks)producedgreatercocaineabstinencecomparedwiththecontrol(100) cashbased incentives (checks) produced greater cocaine abstinence compared with the control (100)cashbasedincentives(checks)producedgreatercocaineabstinencecomparedwiththecontrol(0) condition, but a magnitude effect was not seen for goods-based incentives (vouchers). A trend was observed for greater rates of abstinence in the cash-based versus goods-based incentives at the 50and50 and 50and100 magnitudes. Receipt of $100 checks did not increase subsequent rates of cocaine use above those seen in control conditions. The efficacy and safety data provided in this and other recent studies suggest that use of cash-based incentives deserves consideration for clinical applications of contingency management, but additional confirmation in research using larger samples and more prolonged periods of incentive delivery is needed.
Criminal Justice and Behavior, 2009
This study assessed a 26-week voucher-based intervention to reinforce abstinence and participation in treatment-related activities among substance-abusing offenders court referred to outpatient treatment under drug diversion legislation (California's Substance Abuse and Crime Prevention Act). Standard treatment consisted of criminal justice supervision and an evidence-based model for treating stimulant abuse. Participants were randomly assigned to four groups, standard treatment (ST) only, ST plus vouchers for testing negative, ST plus vouchers for performing treatment plan activities, and ST plus vouchers for testing negative and/or performing treatment plan activities. Results indicate that voucher-based reinforcement of negative urines and of treatment plan tasks (using a flat reinforcement schedule) showed no statistically significant effects on measures of retention or drug use relative to the standard treatment protocol. It is likely that criminal justice contingencies had a stronger impact on participants' treatment retention and drug use than the relatively low-value vouchers awarded as part of the treatment protocol.
Drug and Alcohol Dependence
Background-Rates of young adult cannabis use are rising, perceived harm is at its historical nadir, and most users do not want to quit. Most studies evaluating effects of cannabis use in young adults are cross-sectional, limiting causal inference. A method to reliably induce abstinence periods in cannabis users would allow assessment of the effects of abstinence and resumption of use on a variety of outcomes in a within subjects, repeated measure design. Methods-We examined the efficacy and feasibility of a voucher-based contingency management procedure for incentivizing one month of continuous cannabis abstinence among young adults who reported at least weekly cannabis use, volunteered to participate in a laboratory study, and did not express desire to discontinue cannabis use long-term. Continuous cannabis abstinence was reinforced with an escalating incentive schedule, and self-report of abstinence was confirmed by frequent quantitative assays of urine cannabis metabolite (THCCOOH)
Journal of Substance Abuse Treatment, 2009
Data from 399 adolescents, who participated in one of four randomly controlled trials of the A-CRA intervention, were used to examine the extent to which exposure to Adolescent Community Reinforcement Approach (A-CRA) procedures mediated the relationship between treatment retention and outcomes. Although zero-order correlations indicated that retention in treatment was a significant predictor of AOD use (r = -.18, p < .001), this relationship was reduced to nonsignificance (p = .39) when exposure to A-CRA procedures was included in the model. Overall, the final model evidenced a very good fit (RMSEA=.00; NFI = .99; CFI = 1.00), and explained 29% and 43% of the variance in adolescents' post-treatment AOD use and AOD-related problems, respectively. Additionally, CHAID analysis was used to derive a target level of A-CRA exposure, which was found to be significantly related to being in recovery at follow-up. The current findings are useful, as little research to date has identified significant mediators of the relationship between retention and treatment outcomes or identified target thresholds of treatment exposure.
Archives of General Psychiatry, 2005
Context: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings. Objective: To evaluate the efficacy of an abstinencebased contingency management intervention as an addition to usual care in community treatment settings. Design: Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks. Setting: Eight community-based outpatient psychosocial drug abuse treatment programs. Participants: A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment. Intervention: All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent. Main Outcome Measures: Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant-and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence. Results: Participants assigned to the abstinence-based incentive condition remained in treatment for a mean±SD of 8.0±4.2 weeks and attended a mean±SD of 19.2±16.8 counseling sessions compared with 6.9±4.4 weeks and 15.7±14.4 sessions for those assigned to the usual care condition (PϽ.02 for all). Participants in the abstinencebased incentive condition also submitted significantly more stimulant-and alcohol-free samples (PϽ.001). The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively. However, the percentage of positive samples submitted was low overall and did not differ between conditions. Conclusion: The abstinence-based incentive procedure, which provided a mean of $203 in prizes per participant, was efficacious in improving retention and associated abstinence outcomes.