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Clay S, Wilkinson Z, Ginley M, Arunogiri S, Christmass M, Membrey D, MacCartney P, Sutherland R, Colledge-Frisby S, Marshall AD, Nagle J, Degenhardt L, Farrell M, McKetin R. The reflections of health service providers on implementing contingency management for methamphetamine use disorder in Australia. Drug Alcohol Rev 2024; 43:1313-1322. [PMID: 38704742 DOI: 10.1111/dar.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Contingency management (CM) is the most effective treatment for reducing methamphetamine use. We sought to understand why CM has not been taken up to manage methamphetamine use disorder in Australia. METHODS Six focus groups (4-8 participants per group) were conducted with health workers from agencies in Australia that provided drug-related health care to people who use methamphetamine. These agencies had no previous experience delivering CM for substance use. The potential acceptability and feasibility of implementing CM in their services were discussed. RESULTS Participants felt that it would be beneficial to have an evidence-based treatment for methamphetamine use disorder. This sentiment was offset by concerns that CM conflicted with a client-centred harm-reduction approach and that it dictated the goal of treatment as abstinence. It was also perceived as potentially coercive and seen to reify the power imbalance in the therapeutic relationship and therefore potentially reinforce stigma. There was also concern about the public's perception and the political acceptability of CM, who would fund CM, and the inequity of providing incentives only to clients with a methamphetamine use disorder. Some concerns could be ameliorated if the goals and structure of CM could be tailored to a client's needs. DISCUSSION AND CONCLUSIONS Many healthcare workers were keen to offer CM as an effective treatment option for people with methamphetamine use disorder, but CM would need to be sufficiently flexible to allow it to be tailored to client needs and implemented in a way that did not adversely impact the therapeutic relationship.
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Affiliation(s)
- Simon Clay
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Zachary Wilkinson
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Shalini Arunogiri
- Turning Point & Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Michael Christmass
- Next Step Community Alcohol and Other Drugs Service, Mental Health Commission, Perth, Australia
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- National Drug Research Institute, Melbourne, Australia
| | - Alison D Marshall
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Jack Nagle
- Connections Based Living, Melbourne, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Pfund RA, Ginley MK, Boness CL, Rash CJ, Zajac K, Witkiewitz K. Contingency Management for Drug Use Disorders: Meta-Analysis and Application of Tolin's Criteria. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2024; 31:136-150. [PMID: 38863566 PMCID: PMC11164545 DOI: 10.1037/cps0000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Several professional organizations and federal agencies recommend contingency management (CM) as an empirically supported treatment for drug use disorder. However, the release of the "Tolin criteria" warrants an updated recommendation. Using this methodology, five meta-analyses (84 studies, 11,000 participants) were reviewed. Two meta-analyses were rated moderate quality, and three were rated low or critically low quality. Comparator conditions included active treatment, placebo, treatment as usual, and no treatment. The primary outcome was abstinence. Considering only the moderate quality meta-analyses, the effect of CM versus control on posttreatment abstinence was d = 0.54 [0.43, 0.64] and follow-up abstinence was d=0.08 [0.00, 0.16]. A "strong" recommendation was provided for CM as an empirically supported treatment for drug use disorder.
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Affiliation(s)
- Rory A. Pfund
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
| | | | | | - Carla J. Rash
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Kristyn Zajac
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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Hersi M, Corace K, Hamel C, Esmaeilisaraji L, Rice D, Dryburgh N, Skidmore B, Garber G, Porath A, Willows M, MacPherson P, Sproule B, Flores-Aranda J, Dickey C, Hutton B. Psychosocial and pharmacologic interventions for problematic methamphetamine use: Findings from a scoping review of the literature. PLoS One 2023; 18:e0292745. [PMID: 37819931 PMCID: PMC10566716 DOI: 10.1371/journal.pone.0292745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
RATIONALE Methamphetamine use and related harms have risen at alarming rates. While several psychosocial and pharmacologic interventions have been described in the literature, there is uncertainty regarding the best approach for the management of methamphetamine use disorder (MUD) and problematic methamphetamine use (PMU). We conducted a scoping review of recent systematic reviews (SR), clinical practice guidelines (CPG), and primary controlled studies of psychosocial and pharmacologic treatments for MUD/PMU. METHODS Guided by an a priori protocol, electronic database search updates (e.g., MEDLINE, Embase) were performed in February 2022. Screening was performed following a two-stage process, leveraging artificial intelligence to increase efficiency of title and abstract screening. Studies involving individuals who use methamphetamine, including key subgroups (e.g. those with mental health comorbidities; adolescents/youths; gay, bisexual, and other men who have sex with men) were sought. We examined evidence related to methamphetamine use, relapse, use of other substances, risk behaviors, mental health, harms, and retention. Figures, tables and descriptive synthesis were used to present findings from the identified literature. RESULTS We identified 2 SRs, one CPG, and 54 primary studies reported in 69 publications that met our eligibility criteria. Amongst SRs, one concluded that psychostimulants had no effect on methamphetamine abstinence or treatment retention while the other reported no effect of topiramate on cravings. The CPG strongly recommended psychosocial interventions as well as self-help and family support groups for post-acute management of methamphetamine-related disorders. Amongst primary studies, many interventions were assessed by only single studies; contingency management was the therapy most commonly associated with evidence of potential effectiveness, while bupropion and modafinil were analogously the most common pharmacologic interventions. Nearly all interventions showed signs of potential benefit on at least one methamphetamine-related outcome measure. DISCUSSION This scoping review provides an overview of available interventions for the treatment of MUD/PMU. As most interventions were reported by a single study, the effectiveness of available interventions remains uncertain. Primary studies with longer durations of treatment and follow-up, larger sample sizes, and of special populations are required for conclusive recommendations of best approaches for the treatment of MUD/PMU.
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Affiliation(s)
- Mona Hersi
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kim Corace
- Ottawa Hospital Research Institute, Ottawa, Canada
- Substance Use and Concurrent Disorders Program, The Royal Ottawa Mental Health Centre, Ottawa, Ontario Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Danielle Rice
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Nicole Dryburgh
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Gary Garber
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Amy Porath
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Melanie Willows
- Substance Use and Concurrent Disorders Program, The Royal Ottawa Mental Health Centre, Ottawa, Ontario Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paul MacPherson
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Beth Sproule
- Department of Pharmacy, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Chandlee Dickey
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Transcranial Stimulation for the Treatment of Stimulant Use Disorder. Neurol Int 2023; 15:325-338. [PMID: 36976664 PMCID: PMC10051697 DOI: 10.3390/neurolint15010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
The increasing prevalence of stimulant use disorder (StUD) involving methamphetamine and cocaine has been a growing healthcare concern in the United States. Cocaine usage is associated with atherosclerosis, systolic and diastolic dysfunction, and arrhythmias. Furthermore, approximately one of every four MIs is cocaine-induced among patients aged 18 to 45. Methamphetamine use has been associated with nerve terminal damage in the dopaminergic system resulting in impaired motor function, cognitive decline, and co-morbid psychiatric disorders. Current treatment options for StUD are extremely limited, and there are currently no FDA-approved pharmacotherapies. Behavioral interventions are considered first-line treatment; however, in a recent meta-analysis comparing behavioral treatment options for cocaine, contingency management programs provided the only significant reduction in use. Current evidence points to the potential of various neuromodulation techniques as the next best modality in treating StUD. The most promising evidence thus far has been transcranial magnetic stimulation which several studies have shown to reduce risk factors associated with relapse. Another more invasive neuromodulation technique being studied is deep-brain stimulation, which has shown promising results in its ability to modulate reward circuits to treat addiction. Results showing the impact of transcranial magnetic stimulation (TMS) in the treatment of StUD are limited by the lack of studies conducted and the limited understanding of the neurological involvement driving addiction-based diseases such as StUD. Future studies should seek to provide data on consumption-reducing effects rather than craving evaluations.
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Traxler HK, Kaplan BA, Rzeszutek MJ, Franck CT, Koffarnus MN. Interest in and perceived effectiveness of contingency management among alcohol drinkers using behavioral economic purchase tasks. Exp Clin Psychopharmacol 2023; 31:127-139. [PMID: 35708948 PMCID: PMC10103538 DOI: 10.1037/pha0000580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Contingency management (CM), in which financial incentives are provided upon verification of abstinence from alcohol, cigarettes, and/or illicit substances, is one of the most highly effective and empirically supported treatments for substance use disorders. However, the financial cost of implementation has been identified as a major barrier to implementation of this treatment. The purpose of this study was to develop behavioral economic purchase tasks to assess interest in CM as a function of treatment cost and perceived effectiveness of CM as a function of abstinence incentive size in alcohol drinkers. Alcohol drinkers recruited from Amazon Mechanical Turk (MTurk) completed behavioral economic purchase tasks measuring demand for CM based on targeted abstinence intervals and treatment effectiveness and alcohol use disorder severity assessments. Nonlinear mixed-effects modeling was used to fit demand curves and assess the relationship between individual characteristics and demand metrics for CM. Results reveal that participants reported higher probability of remaining abstinent from drinking when offered larger incentives and required larger incentives when duration of abstinence required to earn the incentive was increased. Additionally, willingness to pay for treatment increased as effectiveness of treatment increased. Abstinence interval and treatment effectiveness are important features to consider when developing effective CM for widespread use, as these variables affected participants' likelihood of being abstinent and their interest in treatment. Future work will validate these assessments with actual treatment outcomes and determine predictors of CM treatment effectiveness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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King CP, Meyer PJ. The incentive amplifying effects of nicotine: Roles in alcohol seeking and consumption. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2022; 93:171-218. [PMID: 35341566 DOI: 10.1016/bs.apha.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nicotine has a unique profile among drugs of abuse. To the noninitiated user, nicotine has powerful aversive effects and its relatively weak euphorigenic effects undergo rapid tolerance. Despite this, nicotine is commonly abused despite negative heath consequences, and nicotine users have enormous difficulty quitting. Further, nicotine is one of the most commonly co-abused substances, in that it is often taken in combination with other drugs. One explanation of this polydrug use is that nicotine has multiple appetitive and consummatory conditioning effects. For example, nicotine is a reinforcement enhancer in that it can potently increase the incentive value of other stimuli, including those surrounding drugs of abuse such as alcohol. In addition, nicotine also has a unique profile of neurobiological effects that alter regulation of alcohol intake and interoception. This review discusses the psychological and biological mechanisms surrounding nicotine's appetitive conditioning and consummatory effects, particularly its interactions with alcohol.
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Affiliation(s)
- Christopher P King
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, United States; Clinical and Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY, United States
| | - Paul J Meyer
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, United States.
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Ginley MK, Pfund RA, Rash CJ, Zajac K. Long-term efficacy of contingency management treatment based on objective indicators of abstinence from illicit substance use up to 1 year following treatment: A meta-analysis. J Consult Clin Psychol 2021; 89:58-71. [PMID: 33507776 DOI: 10.1037/ccp0000552] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Contingency management (CM) is often criticized for limited long-term impact. This meta-analysis focused on objective indices of drug use (i.e., urine toxicology) to examine the effects of CM on illicit substance use up to 1 year following treatment. METHOD Analyses included randomized trials (k = 23) of CM for stimulant, opioid, or polysubstance use disorders that reported outcomes up to 1 year after the incentive delivery had ended. Using random effects models, odds ratios (OR) were calculated for the likelihood of abstinence. Metaregressions and subgroup analyses explored how parameters of CM treatment, namely escalation, frequency, immediacy, and magnitude of reinforcers, moderated outcomes. RESULTS The overall likelihood of abstinence at the long-term follow-up among participants who received CM versus a comparison treatment (nearly half of which were community-based comprehensive therapies or protocol-based specific therapies) was OR = 1.22, 95% confidence interval [1.01, 1.44], with low to moderate heterogeneity (I² = 36.68). Among 18 moderators, longer length of active treatment was found to significantly improve long-term abstinence. CONCLUSIONS CM showed long-term benefit in reducing objective indices of drug use, above and beyond other active, evidence-based treatments (e.g., cognitive-behavioral therapy, 12-step facilitation) and community-based intensive outpatient treatment. These data suggest that policymakers and insurers should support and cover costs for CM, which is the focus of hundreds of studies demonstrating its short-term efficacy and, now, additional data supporting its long-term efficacy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Miguel AQC, Smith CL, Burduli E, Roll JM, McPherson S. Long-term functioning to provide empirical support for the clinical relevance of treatment outcomes for methamphetamine use disorders. J Subst Abuse Treat 2021; 124:108291. [PMID: 33771286 DOI: 10.1016/j.jsat.2021.108291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/26/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Research has yet to empirically evaluate methamphetamine (MA) use outcome measures commonly used to indicate treatment success. Clinically meaningful outcomes must be associated with long-term functioning in important life domains. This study evaluated the association between different MA use outcomes and long-term life-functioning. METHOD The data that this study used in its secondary analyses were pooled from two treatment trials for MA use disorders (n = 237). The study conducted multiple regression analyses (with multiple imputation for missing data) to determine the association of six within-treatment MA use outcome measures with problem severity in seven life domains and a proxy measure for overall functioning, measured with the Addiction Severity Index (ASI) and assessed at an 8-month follow-up. RESULTS The longest duration of abstinence (LDA) outcome achieved the most consistent performance, being associated with better scores in five of eight ASI outcomes (β ranging from -0.203 to -0.291; p < .01). The complete abstinence during treatment demonstrated the poorest performance and was not significantly associated with any of the ASI outcomes. All other MA use outcome measures were significantly (p < .01) associated with at least one ASI outcome. CONCLUSION This study provides empirical support for the use of LDA as a clinically relevant indicator of treatment success for MA use disorders, while also indicating the limitations of using complete abstinence during treatment to determine treatment success. Based on these findings, providers and researchers should use LDA as a primary outcome for MA use disorder treatments and trials.
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Affiliation(s)
- André Q C Miguel
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, WA, United States; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Crystal L Smith
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, WA, United States
| | - Ekaterina Burduli
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, WA, United States
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Analytics and PsychoPharmacology Laboratory (APPL) and the Program of Excellence in Addiction Research, Washington State University, Spokane, WA, United States
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Brown HD, DeFulio A. Contingency management for the treatment of methamphetamine use disorder: A systematic review. Drug Alcohol Depend 2020; 216:108307. [PMID: 33007699 DOI: 10.1016/j.drugalcdep.2020.108307] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022]
Abstract
Methamphetamine use continues to be an important public health problem. Contingency management is among the most effective interventions for reducing methamphetamine use. It has been more than ten years since the last systematic review of contingency management for methamphetamine use disorder. Since then, an additional ten randomized controlled trials and a variety of other studies have been completed. The present systematic review includes 27 studies. Several factors, most notably problem severity, appear to predict treatment outcome. However, the effectiveness of CM has been demonstrated in studies restricted to MSM, studies restricted to implementation in community programs, and in studies of the general population of methamphetamine users conducted in research treatment programs. There appear to be broad benefits of contingency management intervention, including greater drug abstinence, higher utilization of other treatments and medical services, and reductions in risky sexual behavior. Twenty of the twenty-one studies that reported abstinence outcomes showed an effect of contingency management on abstinence, and seven of the nine studies that reported sexual risk behavior outcomes showed an effect of contingency management in reducing risky sexual behavior. Taken together, recent evidence suggests strongly that outpatient programs that offer treatment for methamphetamine use disorder should prioritize adoption and implementation of contingency management intervention.
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Non-pharmacological interventions for methamphetamine use disorder: a systematic review. Drug Alcohol Depend 2020; 212:108060. [PMID: 32445927 DOI: 10.1016/j.drugalcdep.2020.108060] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Methamphetamine (METH) use is on the rise globally, with the number of treatment seekers increasing exponentially across the globe. Evidence-based therapies are needed to meet rising treatment needs. This systematic review intends to appraise the existing evidence to identify effective non-pharmaceutical approaches for the treatment of METH use disorder. METHODS Five electronic bibliographic databases-Ovid (Medline), Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science and PsycINFO- were searched to identify relevant studies that were published between January 1995 to February 2020. Studies were selected and assessed by two independent reviewers. A systematic review of data from both randomised control trials (RCT) and non-RCTs was conducted to appraise the evidence. RESULTS A total of 44 studies were included in the review. Behavioural interventions, i.e. cognitive behavioural therapy (CBT), contingency management (CM), exercise, residential rehabilitation based therapies, repetitive transcranial magnetic stimulation (rTMS), and matrix model demonstrated treatment efficacy in promoting abstinence, reducing methamphetamine use or craving in the participants. While CM interventions showed the strongest evidence favouring the outcomes assessed, tailored CBT alone or with CM was also effective in the target population. CONCLUSIONS Behavioural interventions should be considered as the first line of treatment for methamphetamine use disorder. Future studies should address the longevity of the effects, and limitations due to smaller sample sizes and high dropout rates to enable better assessment of evidence.
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Okafor CN, Stein DJ, Dannatt L, Ipser J, van Nunen LJ, Lake MT, Krishnamurti T, London ED, Shoptaw S. Contingency management treatment for methamphetamine use disorder in South Africa. Drug Alcohol Rev 2019; 39:216-222. [PMID: 31863530 DOI: 10.1111/dar.13019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/26/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- Chukwuemeka N Okafor
- Division of Infectious Diseases, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Lisa Dannatt
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jonathan Ipser
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lara J van Nunen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Marilyn T Lake
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Tamar Krishnamurti
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Steve Shoptaw
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA.,Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
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Jackson MA, Brown AL, Baker AL, Gould GS, Dunlop AJ. The Incentives to Quit tobacco in Pregnancy (IQuiP) protocol: piloting a financial incentive-based smoking treatment for women attending substance use in pregnancy antenatal services. BMJ Open 2019; 9:e032330. [PMID: 31753890 PMCID: PMC6886985 DOI: 10.1136/bmjopen-2019-032330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION While tobacco smoking prevalence is falling in many western societies, it remains elevated among high-priority cohorts. Rates up to 95% have been reported in women whose pregnancy is complicated by other substance use. In this group, the potential for poor pregnancy outcomes and adverse physical and neurobiological fetal development are elevated by tobacco smoking. Unfortunately, few targeted and effective tobacco dependence treatments exist to assist cessation in this population. The study will trial an evidence-based, multicomponent tobacco smoking treatment tailored to pregnant women who use other substances. The intervention comprises financial incentives for biochemically verified abstinence, psychotherapy delivered by drug and alcohol counsellors, and nicotine replacement therapy. It will be piloted at three government-based, primary healthcare facilities in New South Wales (NSW) and Victoria, Australia. The study will assess the feasibility and acceptability of the treatment when integrated into routine antenatal care offered by substance use in pregnancy antenatal services. METHODS AND ANALYSIS The study will use a single-arm design with pre-post comparisons. One hundred clients will be recruited from antenatal clinics with a substance use in pregnancy service. Women must be <33 weeks' gestation, ≥16 years old and a current tobacco smoker. The primary outcomes are feasibility, assessed by recruitment and retention and the acceptability of addressing smoking among this population. Secondary outcomes include changes in smoking behaviours, the comparison of adverse maternal outcomes and neonatal characteristics to those of a historical control group, and a cost-consequence analysis of the intervention implementation. ETHICS AND DISSEMINATION Protocol approval was granted by Hunter New England Human Research Ethics Committee (Reference 17/04/12/4.05), with additional ethical approval sought from the Aboriginal Health and Medical Research Council of NSW (Reference 1249/17). Findings will be disseminated via academic conferences, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trial Registry (Ref: ACTRN12618000576224).
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Affiliation(s)
- Melissa A Jackson
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Amanda L Brown
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Adrian J Dunlop
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- Drug & Alcohol Clinical Research & Improvement Network, Sydney, New South Wales, Australia
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Burduli E, Skalisky J, Hirchak K, Orr MF, Foote A, Granbois A, Ries R, Roll JM, Buchwald D, McDonell MG, McPherson SM. Contingency management intervention targeting co-addiction of alcohol and drugs among American Indian adults: Design, methodology, and baseline data. Clin Trials 2018; 15:587-599. [PMID: 30156433 DOI: 10.1177/1740774518796151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS American Indian adults have some of the highest alcohol abstinence rates compared to the overall US population. Despite this, many American Indian people are more likely to concurrently use alcohol and illicit drugs and are less likely to participate and remain in outpatient treatment for alcohol and other drug use compared to the general US population. There is limited knowledge about effective interventions targeting alcohol and drug co-addiction among American Indian adults. Contingency management is a behavioral intervention designed to increase drug abstinence by offering monetary incentives in exchange for drug and alcohol negative urine samples. We aim to evaluate and describe a culturally tailored contingency management intervention to increase alcohol and other drug abstinence among American Indian adults residing in a Northern Plains reservation. METHODS This 2 × 2 factorial, randomized controlled trial currently includes 114 American Indian adults with alcohol and/or drug dependence who are seeking treatment. Participants were randomized into one of four groups that received (1) contingency management for alcohol, (2) contingency management for other drug, (3) contingency management for both substances, or (4) no contingency management for either substance. We present descriptive, baseline data to characterize the sample and describe the modified contingency management approach that is specific to the community wherein this trial was being conducted. RESULTS The sample is 49.1% male, with an average age of 35.8 years (standard deviation = 10.4 years). At baseline, 43.0% of the sample tested positive for ethyl glucuronide, 50.9% of participants self-reported methamphetamine as their most used drug, 36.8% self-reported cannabis, and 12.3% self-reported prescription opiates as their most used drug. Among randomized participants, 47.4% tested positive for cannabis, 28.1% tested positive for methamphetamine, 16.7% tested positive for amphetamines, and 2.1% tested positive for opiates. CONCLUSION This is the first study to examine a culturally tailored contingency management intervention targeting co-addiction of two substances among American Indian adults. By establishing a tribal-university partnership to adapt, implement, and evaluate contingency management, we will increase the literature on evidence-based addiction treatments and research, while improving trust for addiction interventions among American Indian communities through ongoing collaboration. Moreover, results have implications for the use of contingency management as an intervention for co-addiction in any population.
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Affiliation(s)
- Ekaterina Burduli
- 1 College of Nursing, Washington State University, Spokane, WA, USA.,2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,3 Analytics and Psychopharmacology Laboratory (APPL), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA
| | - Jordan Skalisky
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA.,5 Behavioral Health Innovations (BHI), Washington State University, Spokane, WA, USA
| | - Katherine Hirchak
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,3 Analytics and Psychopharmacology Laboratory (APPL), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA.,5 Behavioral Health Innovations (BHI), Washington State University, Spokane, WA, USA
| | - Michael F Orr
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,3 Analytics and Psychopharmacology Laboratory (APPL), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA
| | - Albert Foote
- 5 Behavioral Health Innovations (BHI), Washington State University, Spokane, WA, USA
| | | | - Richard Ries
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,6 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John M Roll
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,7 Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- 4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA.,7 Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Michael G McDonell
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,4 Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Spokane, WA, USA.,5 Behavioral Health Innovations (BHI), Washington State University, Spokane, WA, USA.,7 Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Sterling M McPherson
- 2 Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, USA.,3 Analytics and Psychopharmacology Laboratory (APPL), Washington State University, Spokane, WA, USA.,6 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,7 Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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McPherson SM, Burduli E, Smith CL, Herron J, Oluwoye O, Hirchak K, Orr MF, McDonell MG, Roll JM. A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. Subst Abuse Rehabil 2018; 9:43-57. [PMID: 30147392 PMCID: PMC6095117 DOI: 10.2147/sar.s138439] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This review of contingency management (CM; the behavior-modification method of providing reinforcement in exchange for objective evidence of a desired behavior) for the treatment of substance-use disorders (SUDs) begins by describing the origins of CM and how it has come to be most commonly used during the treatment of SUDs. Our core objective is to review, describe, and discuss three ongoing critical advancements in CM. We review key emerging areas wherein CM will likely have an impact. In total, we qualitatively reviewed 31 studies in a systematic fashion after searching PubMed and Google Scholar. We then describe and highlight CM investigations across three broad themes: adapting CM for underserved populations, CM with experimental technologies, and optimizing CM for personalized interventions. Technological innovations that allow for mobile delivery of reinforcers in exchange for objective evidence of a desired behavior will likely expand the possible applications of CM throughout the SUD-treatment domain and into therapeutically related areas (eg, serious mental illness). When this mobile technology is coupled with new, easy-to-utilize biomarkers, the adaptation for individual goal setting and delivery of CM-based SUD treatment in hard-to-reach places (eg, rural locations) can have a sustained impact on communities most affected by these disorders. In conclusion, there is still much to be done, not only technologically but also in convincing policy makers to adopt this well-established, cost-effective, and evidence-based method of behavior modification.
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Affiliation(s)
- Sterling M McPherson
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
| | - Ekaterina Burduli
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
| | - Crystal Lederhos Smith
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
| | - Jalene Herron
- Programs of Excellence in Addictions Research, Washington State University,
- Behavioral Health Interventions (BHI), Washington State University, Spokane, WA, USA
| | - Oladunni Oluwoye
- Programs of Excellence in Addictions Research, Washington State University,
- Behavioral Health Interventions (BHI), Washington State University, Spokane, WA, USA
| | - Katherine Hirchak
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
| | - Michael F Orr
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
| | - Michael G McDonell
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
| | - John M Roll
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University,
- Programs of Excellence in Addictions Research, Washington State University,
- Analytics and Psychopharmacology Laboratory (APPL), Washington State University,
- Translational Addictions Research Center, Washington State University,
- College of Nursing, Washington State University
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Oluwoye O, Skalisky J, Burduli E, Chaytor NS, McPherson S, Murphy SM, Herron J, Hirchak K, Burley M, Ries RK, Roll JM, McDonell MG. Using a randomized controlled trial to test whether modifications to contingency management improve outcomes for heavy drinkers with serious mental illness. Contemp Clin Trials 2018; 69:92-98. [PMID: 29680318 PMCID: PMC5995562 DOI: 10.1016/j.cct.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In contingency management (CM), individuals receive rewards for alcohol abstinence. CM is associated with reduced alcohol use in adults with co-occurring serious mental illnesses (SMI). Pre-treatment urine ethyl glucuronide (uEtG) levels equivalent to daily heavy drinking (uEtG >349ng/mL) are associated with poor response to CM. Modifications to CM are needed to improve outcomes for non-responders. AIMS To determine if pre-treatment heavy drinkers, defined by uEtG, with SMI achieve higher levels of alcohol abstinence when they receive an increased magnitude of reinforcement for abstinence (High-Magnitude CM) or reinforcers for reduced drinking, prior to receiving reinforcers for abstinence (Shaping CM), relative to those who receive typical low-magnitude abstinence based CM (Usual CM). Additionally, variables in the Addictions Neuroclinical Assessment model will be examined as treatment response moderators. METHODS Participants (N=400) will be recruited from two urban mental health organizations and complete a 4-week induction period where they will be reinforced for submitting samples for uEtG testing. Participants who attain a mean uEtG >349mg/mL will be randomized to receive either Usual CM, High-Magnitude CM, or Shaping CM for 16weeks. Differences in abstinence, assessed by uEtG, will be examined during treatment and during a 12-month follow-up. Measures of negative emotionality, alcohol reinforcer salience, and executive functioning will be gathered at study intake and used to predict treatment outcomes. DISCUSSION This novel approach to CM will use an alcohol biomarker to identify those at risk for treatment non-response and determine if adaptations to CM might improve outcomes for this group.
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Affiliation(s)
- Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Ekaterina Burduli
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; College of Nursing, Washington State University, Spokane, WA, United States
| | - Naomi S Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States; Providence Medical Research Center, Providence Health Care, Spokane, WA, United States; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Sean M Murphy
- Department of Healthcare Policy and Research, Weill Cornell Medical College, NY, New York, United States
| | - Jalene Herron
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Katherine Hirchak
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Mason Burley
- Health Policy and Administration, Washington State University, Spokane, WA, United States
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, United States; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.
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Dallery J, Raiff BR, Kim SJ, Marsch LA, Stitzer M, Grabinski MJ. Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial. Addiction 2017; 112:875-883. [PMID: 27923264 PMCID: PMC5382065 DOI: 10.1111/add.13715] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/30/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of internet-based CM relative to an internet-based monitoring and goal-setting control group in a nationwide sample of cigarette smokers. DESIGN Randomized controlled trial with 3- and 6-month follow-ups. SETTING United States. PARTICIPANTS Smokers (n = 94) from 26 states were enrolled (mean age 36, 56% female). INTERVENTION AND COMPARATOR Participants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video-verified abstinence using breath carbon monoxide (CO) output (n = 48; abstinent contingent group, AC), or based on submitting CO samples (n = 46, submission contingent, SC). Both groups also received the same CO-based goals. A $50 deposit was required in both groups that could be recouped from initial earnings. MEASURES The primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3- and 6-month follow-ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0-100-mm visual analog scale. FINDINGS Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups [odds ratio (OR) = 4.4, 95% confidence interval (CI) = 1.6-12.3], but not at the 3- (29.2% AC and 19.6% SC, OR = 1.7, 95% CI = 0.6-4.4) or 6- (22.9% AC and 13.0% SC, OR = 2.0, 95% CI = 0.7-5.9) month follow-ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, OR = 3.5, 95% CI = 3.1-4.0; 43.4% AC and 24.6% SC, OR = 2.3, 95% CI = 1.6-3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = -10.3 to 23.8 %, F < 1, P = 0.39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money. CONCLUSIONS A contingency management/financial incentive program delivered via the internet improved short-term abstinence rates compared with an internet program without the incentives.
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Affiliation(s)
- Jesse Dallery
- University of Florida, Gainesville, FL, National Development and Research Institutes, New York, NY
| | | | | | | | - Maxine Stitzer
- The Johns Hopkins University School of Medicine, Baltimore, MD
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