A Randomized Controlled Trial of Contingency Management Therapy in Enhancing Treatment Engagement in a Drug Rehabilitation Centre

Abstract

Background and aims: Contingency management (CM) is a highly effective intervention and has been widely tested and evaluated in the context of substance abuse treatment worldwide. However, this approach is still new in developing countries such as Malaysia. This article aims at determining the effect of CM on treatment engagement within a psychosocial program in a compulsory treatment center in Malaysia. Methods: A randomized controlled trial design was used in this study. A total of 45 methamphetamine-dependent inmates were selected as subjects and randomly assigned into two groups namely the experimental group of treatment as usual + contingency management (TAU+CM) (n=22) and the controlled group of treatment as usual (TAU) (n=23). The TAU+CM group followed a 12-week CM intervention and 4-week follow up session without CM reinforcement. Meanwhile, the TAU group went through 16 weeks of usual psychosocial session implemented in the center. Measurements: The primary outcome of the study was treatment engagement within treatment sessions. It is measured by three parameters which are the assessment of (1) homework completion, (2) active participation and (3) understanding of treatment session. CM reinforcement in a form of star stickers with certain monetary value was given to subjects who achieved the targeted goal in the TAU+CM group. The value of the stickers started from RM2.00 and the magnitude would increase every four weeks. No reinforcement was given in the TAU group. Findings: The TAU+CM group seemed to enhance the treatment engagement within the 12-week psychosocial program. Overall, both groups have showed an increased treatment engagement with the TAU+CM group has a higher achievement than the TAU group. However, the overall differences between the groups were not statistically significant, thus rejecting the main hypothesis of the study which hypothesized that there will be significant differences in treatment engagement between the TAU+CM group and TAU group. Conclusion: The study of CM in a special population, especially in a compulsory treatment center, has been very challenging for researchers. Some studies had similar insignificant result could be due to the special population effect which needs to be further investigated in future studies.