Effects of Lower-Cost Incentives on Stimulant Abstinence in Methadone Maintenance Treatment

Peirce, Jessica M.; Petry, Nancy M.; Stitzer, Maxine L.; Blaine, Jack; Kellogg, Scott; Satterfield, Frank; Schwartz, Marion; Krasnansky, Joe; Pencer, Eileen; Silva-Vazquez, Lolita; Kirby, Kimberly C.; Royer-Malvestuto, Charlotte; Roll, John M.; Cohen, Adam S.; Copersino, Marc L.; Kolodner, Ken; Li, Rui

doi:10.1001/archpsyc.63.2.201

Cited by 283 publications

(297 citation statements)

References 37 publications

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“…However, the 100 mg/day dose is generally considered adequate for most patients, and it is higher than that used in other trials of CM in methadone-maintained populations. For example, the approximate mean methadone doses were 70 mg/day in Petry and Martin (2002), 86 mg/day in Peirce et al (2006), 50-70 mg/day in Epstein, Hawkins, Covi, Umbricht, and Preston (2003), and 65-85 mg/day in Schottenfeld et al (2005). These studies showed significant decreases in cocaine and/or opiate use at the doses tested.…”

Section: Discussionmentioning

confidence: 89%

“…Our patients in the high-density contingent group received prizes worth on average only $286 during the 12-week intervention, less than the cost of commonly studied voucher-based CM procedures (Downey, Helmus, & Schuster, 2000;Higgins, Badger, & Budney, 2000;Piotrowski et al, 1999;Robles et al, 2000;Silverman et al, 1996). Thus, our procedure may be more amenable to implementation in community-based settings (Peirce et al, 2006;Willenbring, Hagedorn, Postier, & Kenny, 2004).The clinical significance of our results is underscored by the finding that, in the contingentreinforcement groups, there were significantly more patients in remission of DSM-IV diagnoses of cocaine dependence at the end of treatment and during the 3 and 6 months postdischarge follow-up periods compared with yoked control participants receiving prize draws irrespective of drug abstinence. This suggests that decreases in problems associated with cocaine use persisted after treatment ended in the contingent groups.…”

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confidence: 99%

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Randomized trial of prize-based reinforcement density for simultaneous abstinence from cocaine and heroin.

Ghitza¹,

Epstein²,

Schmittner³

et al. 2007

Journal of Consulting and Clinical Psychology

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To examine the effect of reinforcer density in prize-based abstinence reinforcement, heroin/cocaine users (N = 116) in methadone maintenance (100 mg/day) were randomly assigned to a noncontingent control group (NonC) or to 1 of 3 groups that earned prize draws for abstinence: manual drawing with standard prize density (MS) or computerized drawing with standard (CS) or high (CH) density. Probabilities (prizes/draw) were standard (50%) and high (78%); prize density was double blind. Mean prize values were CH, $286; CS, $167; MS, $139; and NonC, $171. Outcomes were % opioid/ cocaine-negative urines during the 12-week intervention and then 8 weeks postintervention as well as diagnosis of dependence up to 6 months poststudy. CH had significantly more negative specimens than did NonC during intervention and had more than all groups during postintervention treatment: Mean % negative (95% confidence interval) during postintervention treatment adjusted for baseline drug use and dropout were CH, 55% (14%-90%); CS, 7% (1%-27%); MS, 4% (1%-12%); and NonC, 3% (1%-10%). Current cocaine dependence diagnoses after treatment were significantly lower in contingent compared with noncontingent groups. Computerized drawing with higherdensity prizes enhanced reduction of cocaine use; abstinence reinforcement had long-term therapeutic benefits. Keywords contingency management; opiate; cocaine dependence; opiate dependence; methadone maintenance One of the most robust means of inducing behavioral change in patients with heroin and cocaine dependence is a set of behavioral techniques called contingency management (CM;Higgins et al., 1991;Higgins & Silverman, 1999). An especially powerful component of CM is a voucherbased escalating-reinforcement schedule developed by Higgins et al. (1991), in which reinforcement increases with each consecutive drug-negative urine sample. This procedure has repeatedly been shown effective in the treatment of cocaine abuse and dependence, with or without concurrent dependence on heroin (Higgins et al., 1991;Silverman et al., 1996). Compared with a control procedure in which equivalent values of vouchers are given independent of cocaine use, the escalating-reinforcement procedure reduces the frequency of cocaine use, increases the mean duration of abstinence, reduces patients' ratings of their desire for cocaine, and increases the frequency with which abstainers report engaging in coping behaviors .Correspondence concerning this article should be addressed to Udi E. Ghitza, Clinical Pharmacology and Therapeutics Branch, Treatment Section, IRP, NIDA, NIH, 5500 Nathan Shock Drive, Baltimore, MD 21224. E-mail: ghitzau@intra.nida.nih.gov. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThe voucher reinforcers used in the escalating-reinforcement procedure are certificates presented immediately on provision of a drug-negative urine sample; monetary values indicated on the certificates accrue and are redeemable later for a variety of goods and services. The use...

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Section: Discussionmentioning

confidence: 89%

mentioning

confidence: 99%

Randomized trial of prize-based reinforcement density for simultaneous abstinence from cocaine and heroin.

Ghitza¹,

Epstein²,

Schmittner³

et al. 2007

Journal of Consulting and Clinical Psychology

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show abstract

“…Study results demonstrated a reduction in stimulant use for all groups; CM produced significantly increased retention and reduced stimulant use during the treatment period, although there was no difference between the groups at follow-up. Peirce et al [19] randomised 388 methamphetamine users enrolled in methadone maintenance treatment (MMT) to usual care with or without incentives for 12 weeks. Usual care consisted of MMT and individual and group counselling as required by the clinic, in this sample up to three times a week.…”

Section: Contingency Managementmentioning

confidence: 99%

A systematic review of cognitive and behavioural therapies for methamphetamine dependence

Lee

Rawson

2008

Drug and Alcohol Review

228

176

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Introduction and Aims. The use of methamphetamine is widespread and poses significant challenges for treatment providers. Much of the treatment knowledge about this group has been extrapolated from studies of treatment for cocaine dependence. Medications have been shown to be of limited effectiveness for methamphetamine users, making psychological interventions the treatment of choice. Approach. This paper describes a systematic review of cognitive -behavioural and behavioural interventions for methamphetamine users. A systematic search of published literature was undertaken focusing only on randomised trials. Key Findings. There were a relatively small number of intervention studies that compared cognitivebehavioural or behavioural interventions using randomised trial methodology. Most commonly, studies examined cognitivebehaviour therapy (CBT) and/or contingency management (CM). Treatment with CBT appears to be associated with reductions in methamphetamine use and other positive changes, even over very short periods of treatment (two and four sessions). CM studies found a significant reduction of methamphetamine during application of the procedure, but it is not clear if these gains are sustained at post-treatment follow-up. Implications. The review highlights that there are effective treatments for methamphetamine dependence. Alcohol and other drug (AOD) clinicians are familiar with these types of interventions and should use them and convey to clients that they are effective. Services and policy makers should ensure that best practice interventions are implemented within AOD services. Conclusion. Psychological intervention is effective in addressing methamphetamine use and dependence. CBT and contingency management are two accessible interventions that are implemented easily within current AOD services. There is still more work to conduct in improving methamphetamine treatment, however, and further research into cognitive -behavioural and behavioural treatments for methamphetamine users is required, with a focus on improving longevity of the effect of intervention and improving effectiveness among more complex presentations.[Lee NK, Rawson RA. A systematic review of cognitive and behavioural therapies for methamphetamine dependence. Drug Alcohol Rev 2008;27:309-317]

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“…Findings from these clinical trial protocols are now in press. They showed that the contingency management techniques tested in the CTN were associated with a greater likelihood of stimulant-free and alcohol-free urine tests and of multiple consecutive clean urines in methadone settings (Peirce et al, 2006), and they improved both drug use and retention in outpatient "drug-free" settings (Petry et al, 2005). Dissemination materials are now being developed by ATTCs for distribution to the field at large, and at least one case study documenting the successful adoption and adaptation of these techniques in a large hospital system as a result of CTN exposure has been published (Kellogg et al, 2005).…”

Section: Voucher-based Motivational Incentivesmentioning

confidence: 99%

Innovation adoption in substance abuse treatment: Exposure, trialability, and the Clinical Trials Network

Ducharme

Knudsen

Roman

et al. 2007

Journal of Substance Abuse Treatment

103

151

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Researchers and policymakers are increasingly focusing on factors that facilitate or impede the diffusion of evidence-based treatment techniques into routine clinical practice. One potentially fruitful avenue of research is the influence of involvement in research networks as a predictor of organizational innovation. The Clinical Trials Network (CTN) is examining a number of behavioral and pharmacological treatment techniques in controlled multisite studies. Using data from participating CTN treatment programs and large samples of programs outside the CTN, these analyses examine the influence of exposure to clinical trials on the subsequent adoption of buprenorphine and voucher-based motivational incentives. The analyses show that, controlling for a variety of organizational characteristics, direct exposure to buprenorphine clinical trials in the CTN significantly increased the odds of subsequent adoption. By contrast, the adoption of motivational incentives was entirely explained by organizational characteristics. The findings suggest that adoption of treatment innovations is a function of exposure, organizational resources, nature of innovations, and stage of the diffusion process.

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Effects of Lower-Cost Incentives on Stimulant Abstinence in Methadone Maintenance Treatment

Abstract: An abstinence incentive approach that paid 120 dollars in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.

Cited by 283 publications

References 37 publications

Randomized trial of prize-based reinforcement density for simultaneous abstinence from cocaine and heroin.

Randomized trial of prize-based reinforcement density for simultaneous abstinence from cocaine and heroin.

A systematic review of cognitive and behavioural therapies for methamphetamine dependence

Innovation adoption in substance abuse treatment: Exposure, trialability, and the Clinical Trials Network

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