Low-cost contingency management in community clinics: Delivering incentives partially in group therapy.

Abstract

This study examined the feasibility and effectiveness of prize-based contingency management (CM) when incentives for attendance were administered in group therapy and incentives for abstinence were administered in individual meetings. Three community substance abuse treatment programs participated in this two-phase, crossover design study. Outpatients (N = 103) entering treatment who met diagnostic criteria for cocaine, opiate, and alcohol abuse or dependence were recruited. During the standard condition, participants received standard treatment and submitted breath and urine samples that were tested for alcohol, cocaine, and opiates twice weekly during Weeks 1-6 and once weekly during Weeks 7-12. During the CM condition, participants received the same standard treatment and sample and attendance monitoring, plus the opportunity to win prizes for negative samples and treatment attendance. Demographic information and substance abuse history were evaluated at intake, and posttreatment substance use (toxicology results and self-report) was evaluated at Month 6 and Month 9 follow-up interviews. Primary outcomes were weeks retained in treatment and longest duration of sustained abstinence (LDA). LDA was significantly greater in CM-condition participants, but weeks retained did not differ between groups. Rates of substance use were lower in CM participants at Month 9 but not at Month 6. This study suggests that it is feasible to deliver incentives for attendance in group therapy, but that further research is needed to understand the modest effects on attendance. Strengths and limitations of this study are discussed.

Contingency management treatment for substance use disorders: How far has it come, and where does it need to go?

“…Many studies have evaluated post-intervention effects of CM on substance use months after external reinforcement ceases, but most are underpowered to detect long term changes. Although meta-analyses find effects of CM are not sustained at long term follow-ups (Benishek et al, 2014; Prendergast et al, 2006), an increasing number of studies demonstrate benefits of CM months after treatment ends (Alessi, Hanson, Wieners, & Petry 2007; Carroll et al, 2016; Halpern et al, 2015; Higgins et al, 2000, 2007; Higgins, Heil, & Lussier 2004; Kadden, Litt, Kabela-Cormier, & Petry 2007; Kendzor et al, 2015; McDonell et al, 2013; McKay et al, 2010; Petitjean et al, 2014; Petry, Andrade, Barry, & Byrne 2013c; Petry, Alessi, Byrne, & White 2015b; Petry & Martin 2002; Petry et al, 2005c; Reback et al, 2010; Roll, Chudzynski, Cameron, Howell, & McPherson 2013; Secades-Villa et al, 2011; Secades-Villa, Garcia-Rodriguez, Lopez-Nunez, Alonso-Perez, & Fernandez-Hermida 2014; Schottenfeld, Moore, & Pantalon 2011; Winhusen et al, 2014). A recent review (Davis et al, 2016) reported that 29% of studies that evaluated long-term effects of CM found that it retained significant benefits even after reinforcers were no longer delivered.…”

Use of continuous transdermal alcohol monitoring during a contingency management procedure to reduce excessive alcohol use

“…Nonetheless, several studies indicate that contingency management procedures may effectively reduce excessive alcohol use (e.g., Alessi et al, 2007; Alessi and Petry, 2013; Barnett et al, 2011; Hagedorn et al, 2013; Hunt and Azrin, 1973; Kaffarnus et al, 2011; McDonell et al, 2012; Miller, 1975; Miller et al, 1974a, 1974b; Petry et al, 2000, 2005b). However, to verify abstinence, most studies measured overt signs of intoxication, BAC, and/or BrAC at intervals ranging from daily to once a week.…”

Contingency Management: New Directions and Remaining Challenges for An Evidence-Based Intervention

“…In many studies, CM shows similar rates of relapse to various other SUD therapies. Some studies, however, do find persistent effects of CM post intervention (e.g., Alessi, Hanson, Wieners, & Petry, 2007; Dougherty et al, 2015; Higgins, Badger, & Budney, 2000; Higgins, Wong, et al, 2000; Petry, Martin, & Simcic, 2005; Petry & Martin, 2002). Investigation of factors that promote sustained effects will be important moving forward as will identification of behavioral, neurocognitive and environmental markers that are associated with and predictive of long-term treatment outcomes.…”