No abstract

Contingency management (CM) interventions usually use vouchers as reinforcers, but a new technique awards chances of winning prizes. This study compares these approaches. In community treatment centers, 142 cocaine- or heroin-dependent outpatients were randomly assigned to standard treatment (ST), ST with vouchers, or ST with prizes for 12 weeks. CM patients remained in treatment longer and achieved greater durations of objectively confirmed abstinence than did ST patients; CM conditions did not differ significantly. Although abstinence at 6- and 9-month follow-ups did not differ by group, the best predictor of abstinence was longest duration of abstinence achieved during treatment. Thus, prize and voucher CM systems are equally efficacious in promoting long durations of abstinence, which in turn are associated with benefits posttreatment.

Contingency management (CM) interventions usually reinforce submission of drug-negative specimens, but they can also reinforce adherence with goal-related activities. This study compared the efficacy of the 2 approaches. Substance-abusing outpatients (N = 131) were randomly assigned to 1 of 3 12-week treatments: standard treatment (ST), ST with CM for submitting negative urine toxicology screens, or ST with CM for completing goal-related activities. CM patients remained in treatment longer and achieved more abstinence than ST patients, but the CM condition that reinforced submission of negative samples resulted in better outcomes than the CM condition that reinforced goal-related activities. Abstinence at 6- and 9-month follow-ups did not differ by group, but longest duration of abstinence achieved during treatment was associated with abstinence posttreatment.

Aims Contingency management (CM) uses tangible incentives to systematically reinforce abstinence and is among the most efficacious psychosocial substance abuse treatments. This study assessed the feasibility and initial efficacy of a portable CM procedure designed to address technical limitations for detecting drinking that have prevented using CM for alcohol problems. Design Participants received a cell phone, breathalyzer, and training on video-recording alcohol breath tests (BrACs) and texting results. For 4 weeks, staff texted participants 1–3 times daily indicating a BrAC was due within the hour. Participants were randomized to (1) modest compensation for submitting dated time-stamped BrAC videos regardless of results or (2) the same plus CM with escalating vouchers for on-time alcohol-negative tests (n-BrAC; <02 g/dL). Thank you texts were sent, with CM patients also informed of results-based earnings. Setting Participants’ natural environment. Participants Adults (N=30; ≥21 years) who drank frequently but not physiologically dependent. Measurements Drinking and related problems were assessed at Intake and Week 4. BrACs and self-reports of drinking were collected throughout. The primary outcome was percent of n-BrACs. Other outcomes were longest duration of consecutive n-BrACs (LDA) and self-reports of drinking. Findings On average, 88.6% (10.4%) of BrACs were submitted on time, without group differences (p>.5). Percent of n-BrACs and LDA were greater with CM, and there was an interaction effect on drinking frequency and negative consequences, with decreases over time with CM (p=.00; effect sizes d=.52 to .62). Conclusion Cell phone technology may be useful for extending CM to treatment for alcohol problems.

Objective Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement for specific patient subgroups. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment cocaine positive. Methods Initially cocaine-negative patients (n=333) were randomized to: standard care (SC), SC+CM reinforcing submission of negative samples with $250 in prizes ($250Abs), or SC+CM reinforcing attendance ($250Att). Initially cocaine-positive patients (n=109) were randomized to: SC, $250Abs, or higher magnitude CM ($560Abs). Results For initially cocaine-negative patients, $250Abs and $250Att were equally efficacious to SC in enhancing longest duration of abstinence during treatment (LDA); $250Att patients submitted lower proportions of negative samples when missing samples were considered missing, but these patients also attended more study sessions, provided more samples, and submitted a higher proportion of negative samples than SC patients when expected samples were analyzed, ps<.05. In initially cocaine-positive patients, both CM conditions increased proportions of negative samples relative to SC when missing samples were excluded from analyses, but only $560Abs was efficacious in increasing LDA and proportion of negative samples when expected samples were analyzed, ps<.05. Follow-ups revealed no differences in drug use among groups, but LDA was consistently associated with abstinence during follow-up, p<.05. Conclusions High magnitude abstinence-based reinforcement improved all abstinence outcomes in patients who began treatment while using cocaine. For patients initiating treatment abstinent, both attendance- and abstinence-based CM resulted in improvements on some measures.