Contingency management in substance abuse treatment: A structured review of the evidence for its transportability

Abstract

Aims Extant literature on contingency management (CM) transportability, or its transition from academia to community practice, is reviewed. The Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) guides the examination of this material. Methods PsychInfo and Medline database searches identified 27 publications, with reviewed reference lists garnering 22 others. These 49 sources were examined according to CFIR domains of the intervention, outer setting, inner setting, clinicians, and implementation processes. Results Intervention characteristics were focal in 59% of the identified literature, with less frequent focus on clinicians (34%), inner setting (32%), implementation processes (18%), and outer setting (8%). As intervention characteristics, adaptability and trialability most facilitate transportability whereas non-clinical origin, perceived inefficacy or disadvantages, and costs are impediments. Clinicians with a managerial focus and greater clinic tenure and CM experience are candidates to curry organizational readiness for implementation, and combat staff disinterest or philosophical objection. A clinic’s technology comfort, staff continuity, and leadership advocacy are inner setting characteristics that prompt effective implementation. Implementation processes in successful demonstration projects include careful fiscal/logistical planning, role-specific staff engagement, practical adaptation in execution, and evaluation via fidelity-monitoring and cost-effectiveness analyses. Outer setting characteristics—like economic policies and inter-agency networking or competition—are salient, often unrecognized influences. Conclusions As most implementation constructs are still moving targets, CM transportability is in its infancy and warrants further scientific attention. More effective dissemination may necessitate that future research weight emphasis on external validity, and utilize models of implementation science.

Adapting the Helpful Responses Questionnaire to Assess Communication Skills Involved in Delivering Contingency Management: Preliminary Psychometrics

“…An attribute of CM that should facilitate its community transportability is a capacity for contextual adaptation (Hartzler, Lash, & Roll, 2012). To that end, others may find it useful to amend details of the patient vignette in the HRQ-CM to better match particular features (i.e., target population, patient behavior, involved reinforcers) of local CM interventions they seek to monitor.…”

The Behavioral Economics of Substance Use Disorders: Reinforcement Pathologies and Their Repair

“…CM procedures have been effectively applied to reduce the use of a number of substances (Hartzler et al 2012, Stitzer et al 2007), including cigarettes (Alessi et al 2004, Yi et al 2008), alcohol (Alessi & Petry 2013, Koffarnus et al 2011, Petry et al 2000), cocaine (Higgins et al 1993, Petry et al 2013), marijuana (Carroll et al 2012), and opiates (Bickel & Marsch 1999, Bickel et al 1999a, DeFulio & Silverman 2011, Silverman et al 1996). CM treatment is also associated with increases in quality of life in substance abusers (Petry et al 2007), and cost-effectiveness studies suggest that these interventions result in a net economic gain owing to their relative efficacy and the expense associated with treatment failures in substance-abusing populations (e.g., inpatient treatment, incarceration, increased health care utilization) (Olmstead et al 2012, Sindelar et al 2007).…”

Exercise as an Adjunct Treatment for Opiate Agonist Treatment: Review of the Current Research and Implementation Strategies

“…A commonly stated question is, “who pays for the incentives?” 86 . Due to its efficacy and subsequent reductions in other healthcare costs (i.e., cost-effectiveness) 87 some government agencies, such as the Veterans Administration, and large insurance corporations have assumed the costs and begun widespread implementation.…”