Contingency management treatment for methamphetamine use disorder in South Africa

Abstract

Introduction and Aims As South Africa, especially the Western Cape Province, faces an epidemic of methamphetamine use disorder, therapeutic approaches suited to the South African context are needed. This secondary analysis assessed retention and methamphetamine abstinence outcomes in response to an 8‐week pilot contingency management (CM) intervention trial of neural correlates of methamphetamine abstinence, exploring sociodemographic and clinical differences between responders and non‐responders. Design and Methods Research participants provided thrice‐weekly monitored urine samples, which were analysed by qualitative radioimmunoassay. The primary outcome for this analysis was therapeutic response, defined as abstinence from methamphetamine (≥23 of 24 possible methamphetamine‐negative urine samples). Results Data from 30 adults living in Cape Town, South Africa (34 ± 6.1 years of age, mean age ± SD, 21 men) were included. Sixty‐three percent (12 men) were responders. In bivariate comparisons, baseline measurements showed fewer responders reported monthly household income ≥25 000+ South African Rand (ZAR; ~USD $1880; vs. ZAR < 25 000) than non‐responders (15.8% vs. 63.6%; P = 0.007). Furthermore, responders had higher median years of education (12 vs. 10; Kruskal–Wallis χ2 = 4.25, DF = 1, P = 0.039) and lower median body mass index than non‐responders (19 vs. 24; Kruskal–Wallis χ2 = 6.84, P = 0.008). Discussion and Conclusions Therapeutic response in this study were comparable to those obtained with CM for methamphetamine use disorder in North America and Europe. Our findings suggest that CM may be a useful component of treatment strategies to boost retention and continuous abstinence from methamphetamine in Cape Town, South Africa. Larger efficacy studies are needed in this setting.

Decision-Making by Patients With Methamphetamine Use Disorder Receiving Contingency Management Treatment: Magnitude and Frequency Effects

“…This study was part of a pilot project investigating the suitability of CM in treating MA Use Disorder in South Africa. It used a between-groups, cross-sectional design comparing outcomes to CM (complete response, partial response) among 29 individuals diagnosed with MA Use Disorder (DSM-5) to 20 healthy control participants, see Okafor et al (21). All participants completed neurocognitive and self-report measures, after which MA Use Disorder patients commenced an 8-week, escalating schedule, thrice-weekly, voucher-based CM intervention.…”

Current and Emerging Treatments for Methamphetamine Use Disorder

“…For example, CM participants are provided monetary vouchers in exchange for consecutive urine samples documenting abstinence from METH. A person with METH-positive or missing urine sample is moved down the escalating schedule [ 78 ]. The studies that assessed CM efficacy in reducing METH abuse or dependence showed positive outcomes when comparing MUD patients to control group participants or CM to other behavioral therapies [ 74 , 76 ].…”

An incentive‐based text‐messaging intervention to reduce maternal alcohol use during pregnancy and lactation in South Africa (MaRISA study): Findings from a single‐arm pilot study

“…Additionally, the CM approach has been successfully used in maternal populations to reduce substance and tobacco use (Hand et al, 2017), including smoking cessation (Heil et al, 2008;Higgins et al, 2004Higgins et al, , 2012Tappin et al, 2015;Tuten et al, 2012), cocaine abstinence (Schottenfeld et al, 2011), polysubstance use (Jones et al, 2001;Svikis et al, 2007), and also alcohol use (Washio et al, 2017). The approach was also able to increase methamphetamine abstinence among adults in South Africa (Okafor et al, 2020). Providing incentives contingent on observed behavior facilitates behavior change by increasing the perceived value of a desirable behavior relative to the cost and effort of engaging in an undesirable behavior (Botvinick & Braver, 2015).…”