Abstinence based incentives plus parent training for adolescent alcohol and other substance misuse.

Stanger, Catherine; Scherer, Emily A.; Babbin, Steven F.; Ryan, Stacy R.; Budney, Alan J.

doi:10.1037/adb0000279

“…Contingency management (CM) is an approach that involves offering rewards contingent on engagement in substance use treatment and on evidence of abstinence. CM has now accumulated a robust evidence base in a variety of contexts, including smoking cessation, 26,27 heavy drinking 28 and drug misuse [29][30][31][32][33][34][35] and, in a fairly recent trial of a 12-week CM intervention, it was found to be clinically effective and cost-effective in reducing stimulant misuse in a cohort of patients with severe mental illness. 36 Furthermore, the National Institute for Health and Care Excellence (NICE) has recommended that it be adopted in the UK.…”

Section: Resultsmentioning

confidence: 99%

A contingency management intervention to reduce cannabis use and time to relapse in early psychosis: the CIRCLE RCT

Rains

¹

,

Marwaha

²

,

Strang

³

et al. 2019

Health Technol Assess

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Background Cannabis is the most prevalent illicit substance among people with psychosis, and its use is associated with poorer clinical and social outcomes. However, so far, there has been limited evidence that any treatment is effective for reducing use. Contingency management (CM) is an incentive-based intervention for substance misuse that has a substantial evidence base across a range of substances and cohorts. However, to date there have been no randomised controlled trials (RCTs) of CM as a treatment for cannabis use specifically in psychosis. Objective To conduct a RCT investigating the clinical effectiveness and cost-effectiveness of CM in reducing cannabis use among Early Intervention in Psychosis (EIP) service users. Design The CIRCLE (Contingency Intervention for Reduction of Cannabis in Early Psychosis) trial was a rater-blinded, multicentre RCT with two arms. Participants were randomised 1 : 1 to either an CM arm, in which participants received CM for cannabis use alongside an optimised treatment-as-usual programme including structured psychoeducation, or a control arm in which participants received the treatment as usual only. Setting EIP services across the Midlands and the south-east of England. Participants The main eligibility criteria were EIP service users with a history of psychosis, aged 18–36 years, and having used cannabis at least once per week during 12 of the previous 24 weeks. Intervention The CM intervention offered financial incentives (i.e. shopping vouchers) for cannabis abstinence over 12 once-weekly sessions, confirmed using urinalysis. The maximum value in vouchers that participants could receive was £240. Main outcome measures The main outcome was time to relapse, operationalised as admission to an acute mental health service or hospital. The primary outcome was assessed at 18 months post inclusion using electronic patient records. Secondary outcomes assessed the clinical effectiveness and cost-effectiveness of the intervention, for which data were collected at 3 and 18 months. Results A total of 278 participants were randomised to the CM arm and 273 were randomised to the control arm. In total, 530 (96%) participants were followed up for the primary outcome. There was no significant difference in time to admission between trial arms by 18 months following consent (hazard ratio 1.03, 95% confidence interval 0.76 to 1.40). There were no statistically significant differences in most secondary outcomes, including cannabis use, at either follow-up assessment. There were 58 serious adverse events, comprising 52 inpatient episodes, five deaths and one arrest. Limitations Participant retention was low at 18 months, limiting the assessment of secondary outcomes. A different CM intervention design or reward level may have been effective. Conclusions The CM intervention did not appear to be effective in reducing cannabis use and acute relapse among people with early psychosis and problematic cannabis use. Future work Cannabis use is still a significant clinical concern in this population. A pressing need remains to identify suitable treatments. A wider perspective on the social circumstances of young people with psychosis may be needed for a successful intervention to be found. Trial registration Current Controlled Trials ISRCTN33576045. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 45. See the NIHR Journals Library website for further project information.

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“…Recent evidence continues to support multicomponent psychosocial treatments, as combinations of family-based therapy, cognitive behavioral therapy, motivational interviewing, and contingency management can be effectively utilized to treat adolescent SUDs [9,[18][19][20][21][22][23]. Combinations of motivational enhancement therapy (MET; described below in more detail in section 2) and CBT are well-established interventions for treating adolescent SUD [9,21], and other studies have found that contingency management, an intervention in which an individual is rewarded for positive behavior, can be an effective supplement to MET, CBT, and family-based therapies [19,20].…”

Section: C Multicomponent Psychosocial Therapymentioning

confidence: 99%

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies

Fadus

¹

,

Squeglia

²

,

Valadez

³

et al. 2019

Curr Psychiatry Rep

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Purpose of Review: To examine the most recent published evidence (2016-2019) regarding the treatment of adolescent substance use disorders, and to provide an update on evidence-based strategies, adjunctive interventions, and methods to improve currently established treatment approaches. Recent Findings: Recent evidence suggests that psychosocial treatments such as family-based therapy, cognitive behavioral therapy, and multicomponent approaches remain the most effective methods of treatment; however, innovative ways of improving these treatment strategies may include digital and culturally-based interventions. New advances in adjunctive treatments such as pharmacotherapy, exercise, mindfulness, and recovery-oriented educational centers may have some clinical utility. Summary: Well-established psychosocial interventions remain the primary modality of treatment. Promising new adjunctive treatments and improvements in our currently established treatments may yield significant improvements.

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“…First, given the distribution of data and empirical precedent, alcohol consumption variables were coded as missing when <85% of the TLFB data were available. 40,41 When ≥85% of the TLFB data were available, the number of non-missing days were entered into the denominator to calculate alcohol use percentages. Second, participants who were missing any data included in the proposed models were subsequently removed from the main analyses.…”

Section: Discussionmentioning

confidence: 99%