Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial

Abstract

BackgroundMethamphetamine use is associated with HIV acquisition and transmission among men who have sex with men (MSM). Contingency management (CM), providing positive reinforcement for drug abstinence and withholding reinforcement when abstinence is not demonstrated, may facilitate reduced methamphetamine use and sexual risk. We compared CM as a stand-alone intervention to a minimal intervention control to assess the feasibility of conducting a larger, more definitive trial of CM; to define the frequency of behavioral outcomes to power such a trial; and, to compute preliminary estimates of CM's effectiveness.MethodsWe randomly assigned 127 MSM from Seattle, WA who use methamphetamine to receive a 12-week CM intervention (n = 70) or referral to community resources (n = 57).ResultsRetention at 24 weeks was 84%. Comparing consecutive study visits, non-concordant UAI declined significantly in both study arms. During the intervention, CM and control participants were comparably likely to provide urine samples containing methamphetamine (adjusted relative risk [aRR] = 1.09; 95%CI: 0.71, 1.56) and to report non-concordant UAI (aRR = 0.80; 95%CI: 0.47, 1.35). However, during post-intervention follow-up, CM participants were somewhat more likely to provide urine samples containing methamphetamine than control participants (aRR = 1.21; 95%CI: 0.95, 1.54, P = 0.11). Compared to control participants, CM participants were significantly more likely to report weekly or more frequent methamphetamine use and use of more than eight quarters of methamphetamine during the intervention and post-intervention periods.ConclusionsWhile it is possible to enroll and retain MSM who use methamphetamine in a trial of CM conducted outside drug treatment, our data suggest that CM is not likely to have a large, sustained effect on methamphetamine use.Trial RegistrationClinicalTrials.gov Identifier NCT01174654

A Randomized Trial of Computer-Delivered Brief Intervention and Low-Intensity Contingency Management for Smoking During Pregnancy

“…Second, frequency of assessment and size of reinforcement in CM-Lite were substantially reduced from typical levels. Notably, our study is consistent with findings from another recent trial (Menza et al, 2010) that found no effects for a CM intervention with a mean received total incentive level of $112 (compared with the mean of $461 in Heil et al, 2008). Third, we intentionally did not pair CM-Lite testing sessions with encouragement or advice and did not utilize shaping by ensuring that participants could obtain an initial success.…”

A Systematic Review of Behavioral and Treatment Outcome Studies Among HIV-Infected Men Who Have Sex with Men Who Abuse Crystal Methamphetamine

“…Contingency management (CM) interventions have also been used to treat crystal meth abuse [63][64][65][66][67][68][69] ; however, there is conflicting evidence regarding CM's efficacy. CM is a psychotherapy that provides rewards (e.g., cash or vouchers exchangeable for goods) for the achievement of specific treatment goals (e.g., abstinence from drug use or treatment session attendance).…”

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

“…The reasons for each decision are given in Appendix 3. Articles were excluded for not being a RCT or other suitable study, as specified in our inclusion criteria; not having the sufficient percentage of MSM in the study population; [137][138][139][140][141][142][143][144][145] not including a sufficient percentage of HIV-negative participants; [146][147][148][149][150][151][152][153][154][155][156] or not being an individually focused intervention, instead focusing on groups or structural factors. [157][158][159][160][161][162][163][164][165][166][167] Other reasons for exclusion, such as interventions not being brief, reporting a pilot trial, reporting non-HIV-specific data (e.g.…”