Amount of earnings during prize contingency management treatment is associated with posttreatment abstinence outcomes

The Effectiveness of Ultra-Low Magnitude Reinforcers: Findings From a "Real-World" Application of Contingency Management

BACKGROUND

Research has consistently found contingency management (CM) to be an effective tool in increasing desired patient behaviors in substance use disorder (SUD) treatment. Despite the strong evidence for the effectiveness of this intervention, practical issues and the cost of implementing CM in treatment programs have been significant barriers to adoption.

OBJECTIVES

To evaluate the impact of a CM program designed and implemented by university-affiliated methadone clinic staff to increase patient group attendance. The CM program consisted of a weekly raffle for patients attending clinician-led group counseling and/or in-clinic Methadone Anonymous (MA) groups in which slips with patient ID#s were entered and one ID slip was drawn per week with a fee credit for a dose of methadone ($15) as the prize.

METHODS

The CM program continued for 12 months. Group attendance was tracked before, during, and after CM implementation as part of ongoing clinic service utilization monitoring.

RESULTS

Following the implementation of CM, attendance at any clinician-led or MA groups increased significantly from baseline to month 1 (X²=5.78, p<0.05) but this increase was not sustained beyond month 6. Analysis of attendance by type of group revealed that clinician-led group attendance did not increase significantly but there was a significant increase in in-clinic MA group attendance from baseline to month 1 (X²=20.27, p<0.001), which was sustained through the 12-month implementation period (X²=11.21, p<0.001) and through 3 months post-implementation (X²=14.73; p<0.001).

CONCLUSIONS

A low-cost, simple CM intervention implemented by clinic staff was associated with significant increases in the target behavior of increasing group attendance.

Behavioral Interventions for Individuals Dually-Diagnosed with a Severe Mental Illness and a Substance Use Disorder

The prevalence of substance abuse among severely mentally ill individuals (SMI) with a schizophrenia-spectrum or bipolar disorder is about three times the rate of the general population. However, few effective interventions exist to address the problem. In this paper, we evaluate recent studies of behavioral interventions for substance abuse among SMI individuals. These include cognitive-behavioral, motivational interviewing, and contingency management interventions, as well as combinations thereof. Consistent with prior systematic reviews, ours indicates that no behavioral intervention has clearly demonstrated efficacy beyond that of usual care. Unfortunately, most of the reviewed studies suffer from methodological problems that hamper detection of treatment effects. Also, it can be argued that interventions tested thus far may not be well-suited for this cognitively-impaired population. A programmatic series of studies is needed to further develop and test behavioral interventions for treating substance abuse in this population.

Internet-based contingency management to promote smoking cessation: a randomized controlled study

We evaluated an Internet-based contingency management intervention to promote smoking cessation. Participants in the contingent group (n = 39) earned vouchers contingent on video confirmation of breath carbon monoxide (CO) ≤ 4 parts per million (ppm). Earnings for participants in the noncontingent group (n = 38) were independent of CO levels. Goals and feedback about smoking status were provided on participants' homepages. The median percentages of negative samples during the intervention in the noncontingent and contingent groups were 25% and 66.7%, respectively. There were no significant differences in absolute CO levels or abstinence at 3- and 6-month follow-ups. Compared to baseline, however, participants in both groups reduced CO by an estimated 15.6 ppm during the intervention phases. The results suggest that the contingency for negative COs promoted higher rates of abstinence during treatment, and that other elements of the system, such as feedback, frequent monitoring, and goals, reduced smoking.