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

Abstract

The relationship between psychiatric severity and substance use disorders treatment outcome was assessed in 393 individuals who received either standard treatment or standard treatment plus contingency management. The sample was divided into groups of low, moderate, and high psychiatric severity based upon baseline Addiction Severity Index psychiatric composite scores. Participants in the high psychiatric severity group reported a greater prevalence of psychiatric hospitalization, psychiatric medications, and suicide attempts, as well as poorer baseline psychosocial functioning. In terms of treatment outcome, a significant interaction between psychiatric severity and treatment modality was found in relation to treatment retention. Participants in the standard treatment condition were more likely to dropout of treatment earlier as psychiatric severity increased, while retention was similar across the psychiatric severity groups in the contingency management condition. Psychiatric severity was not linked to longest duration of abstinence achieved during treatment or adherence with contingency management procedures. Overall, these findings suggest contingency management is an efficacious and appropriate intervention for substance use disordered individuals across a range of psychiatric problems.

Contingency management reduces symptoms of psychological and emotional distress among homeless, substance-dependent men who have sex with men

“…Furthermore, in contrast to the common finding that treatment outcomes for substance abuse and dependence are diminished among those with greater severity of psychiatric symptoms and among those with concomitant psychiatric disorders (Charney, Palacios-Boix, Negrete, Dobkin, & Gill, 2005; Compton, Cottler, Jacobs, Ben-Abdallah, & Spitznagel, 2003), CM is associated with greater reductions in substance use and increased retention rates in participants with high psychiatric severity compared to standard treatment (Weinstock, Alessi, & Petry, 2007). CM has also demonstrated efficacy compared to standard substance abuse treatments in producing abstinence among drug abusers with comorbid psychiatric condition(s) (Drake, O’Neal, & Wallach, 2008), with particularly strong findings for cocaine- and opioid-dependent individuals with post-traumatic stress disorder (Mancino et al, 2010) cocaine abusers with antisocial personality disorder (Messina et al, 2003), and substance-dependent, homeless MSM with antisocial personality disorder (Fletcher & Reback 2013).…”

Exercise as an Adjunctive Treatment for Substance Use Disorders: Rationale and Intervention Description

“…For example, symptoms of social anxiety may trigger drinking alcohol due to its ability to reduce uncomfortable feelings (Battista et al, 2015). Unfortunately, psychiatric comorbidity within SUD is frequently associated with greater impairment and poor treatment engagement (Greenfield et al, 1998; Weinstock, Alessi, & Petry, 2007), both of which can lead to poor treatment outcome and relapse to substance use. Conversely, exercise is an effective treatment for both major depression and certain anxiety disorders (e.g., Babyak et al, 2000; Broocks et al, 1998), which are disorders that frequently co-occur with SUD (Grant et al, 2004).…”

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

“…Results suggest that CM is efficacious and generalizable to a wide range of characteristics including income (Rash, Andrade, & Petry, 2013; Rash, Olmstead, & Petry, 2009; Secades-Villa et al, 2013), race (Barry, Sullivan, & Petry, 2009), gender (Burch, Rash, & Petry, 2015; Rash & Petry, 2015), comorbid disorders (Ford, Hawke, Alessi, Ledgerwood, & Petry, 2007; García-Fernández, Secades-Villa, García-Rodríguez, Peña-Suárez, & Sánchez-Hervás, 2013; Rash, Alessi, & Petry, 2008a; Weinstock, Alessi, & Petry, 2007), co-occurring substance use (Alessi, Rash, & Petry, 2011), medical comorbidities (Burch, Morasco, & Petry, 2015; Walter & Petry, 2015), history of prior SUD treatment (Rash, Alessi, & Petry, 2008b), and history of prostitution (Rash, Burki, Montezuma-Rusca, & Petry, 2016). In this issue, Shoptaw and colleagues (2017) have shown that abstinence-based incentives can be effective even outside the context of formal SUD treatment with MSM (men who have sex with men) methamphetamine users enrolled in an HIV risk reduction project.…”