Contingency management treatments: Reinforcing abstinence versus adherence with goal-related activities.

Abstract

Contingency management (CM) interventions usually reinforce submission of drug-negative specimens, but they can also reinforce adherence with goal-related activities. This study compared the efficacy of the 2 approaches. Substance-abusing outpatients (N = 131) were randomly assigned to 1 of 3 12-week treatments: standard treatment (ST), ST with CM for submitting negative urine toxicology screens, or ST with CM for completing goal-related activities. CM patients remained in treatment longer and achieved more abstinence than ST patients, but the CM condition that reinforced submission of negative samples resulted in better outcomes than the CM condition that reinforced goal-related activities. Abstinence at 6- and 9-month follow-ups did not differ by group, but longest duration of abstinence achieved during treatment was associated with abstinence posttreatment.

Regardless of psychiatric severity the addition of contingency management to standard treatment improves retention and drug use outcomes

“…Although treatment condition had a substantial impact on achieving longer durations of abstinence, there was no effect of psychiatric severity on LDA. These analyses were re-run twice, first omitting the CM group that was not reinforced for abstinence (from Petry et al, 2006), and second using a median split of LDA (0-4 weeks abstinent vs. 5-12 weeks abstinent). In both cases, results were similar with study and treatment condition as the only significant variables associated with LDA, p < .05 (data not shown).…”

“…The adjusted percent of samples abstinent (± SE) was 49.2% (0.02) for CM and 37.8% (0.03) for standard treatment. For study, the adjusted percent of samples abstinent (± SE) was 33.3% (0.03) for Petry et al (2004), 54.3% (0.03) for Petry et al (2005b), and 42.8% for Petry et al (2006). Psychiatric severity was not associated with percent of abstinent samples provided, F(2,378) = 1.89, p = .152, nor was the interaction between psychiatric severity and treatment condition, F(2,378) = 1.47, p = .231.…”

“…Data for this study were collected during three separate randomized trials investigating the efficacy of CM in addition to standard intensive outpatient substance abuse treatment (Petry et al, 2004(Petry et al, , 2005b(Petry et al, , 2006. Two trials were multi-site with 2 and 3 community-based substance abuse clinics participating, respectively; the third trial was conducted at a single communitybased substance abuse clinic.…”

“…All participants provided written informed consent, approved by the University of Connecticut Health Center's Institutional Review Board. See Petry et al (2004), Petry et al (2005b), and Petry et al (2006) for main outcome results.…”

“…The difference between the two CM conditions in Petry (2005b) was the type of reinforcement: vouchers or chances to win prizes by drawing from a prize bowl. Petry et al (2006) had two prize CM conditions in which one reinforced abstinence and the other only reinforced completion of goal-related activities, not abstinence. Hence, not all participants assigned to a CM condition were reinforced for both abstinence and goal-related activity completion.…”