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DeFulio A, Rzeszutek MJ, Furgeson J, Ryan S, Rezania S. A smartphone-smartcard platform for contingency management in an inner-city substance use disorder outpatient program. J Subst Abuse Treat 2021; 120:108188. [DOI: 10.1016/j.jsat.2020.108188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/14/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
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Hirchak KA, Leickly E, Herron J, Shaw J, Skalisky J, Dirks LG, Avey JP, McPherson S, Nepom J, Donovan D, Buchwald D, McDonell MG. Focus groups to increase the cultural acceptability of a contingency management intervention for American Indian and Alaska Native Communities. J Subst Abuse Treat 2018; 90:57-63. [PMID: 29866384 PMCID: PMC6014612 DOI: 10.1016/j.jsat.2018.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Many American Indian and Alaska Native (AI/AN) people seek evidence-based, cost-effective, and culturally acceptable solutions for treating alcohol use disorders. Contingency management (CM) is a feasible, low-cost approach to treating alcohol use disorders that uses "reinforcers" to promote and support alcohol abstinence. CM has not been evaluated among AI/AN communities. This study explored the cultural acceptability of CM and adapted it for use in diverse AI/AN communities. METHODS We conducted a total of nine focus groups in three AI/AN communities: a rural reservation, an urban health clinic, and a large Alaska Native healthcare system. Respondents included adults in recovery, adults with current drinking problems, service providers, and other interested community members (n = 61). Focus group questions centered on the cultural appropriateness of "reinforcers" used to incentivize abstinence and the cultural acceptability of the intervention. Focus groups were audio-recorded, transcribed, and coded independently by two study team members using both a priori and emergent codes. We then analyzed coded data. RESULTS Across all three locations, focus group participants described the importance of providing both culturally specific (e.g., bead work and cultural art work supplies), as well as practical (e.g., gas cards and bus passes) reinforcers. Focus group participants underscored the importance of providing reinforcers for the children and family of intervention participants to assist with reengaging with family and rebuilding trust that may have been damaged during alcohol use. Respondents indicated that they believed CM was in alignment with AI/AN cultural values. There was consensus that Elders or a well-respected community member implementing this intervention would enhance participation. Focus group participants emphasized use of the local AI/AN language, in addition to the inclusion of appropriate cultural symbols and imagery in the delivery of the intervention. CONCLUSIONS A CM intervention for alcohol use disorders should be in alignment with existing cultural and community practices such as alcohol abstinence, is more likely to be successful when Elders and community leaders are champions of the intervention, the intervention is compatible with counseling or treatment methodologies, and the intervention provides rewards that are both culturally specific and practical.
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Affiliation(s)
- Katherine A Hirchak
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Emily Leickly
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Jalene Herron
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | | | - Jordan Skalisky
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | | | | | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, WA, USA; Providence Medical Research Center, Providence Health Care, Spokane, WA, USA
| | - Jenny Nepom
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Dennis Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Dedra Buchwald
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, WA, USA
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Department of Medical Education and Clinical Sciences, Washington State University Elson S. Floyd College of Medicine, Spokane, WA, USA.
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The Prevalence of and Factors Associated with Alcohol-Related Problems in a Community Sample of African American Women. JOURNAL OF ADDICTION 2016; 2016:7513827. [PMID: 27752388 PMCID: PMC5056303 DOI: 10.1155/2016/7513827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/20/2016] [Accepted: 08/11/2016] [Indexed: 11/18/2022]
Abstract
Purpose. This study examines the prevalence of alcohol-related problems, the factors underlying these problems, and whether or not there is evidence of syndemic effects in a community population of southern, urban African American women. Methods. Questionnaire-based interviews were conducted with 817 women, all African American, from 80 targeted census block groups in Atlanta, Georgia. Results. Most of the alcohol users (67.8%) experienced at least one problem as a result of their alcohol (ab)use, with most women experiencing two or more such problems. Eight factors were found to be associated with experiencing more alcohol problems: being aged 30 or older, having had no recent health insurance, lower levels of educational attainment, self-identifying as lesbian or bisexual, experiencing greater amounts of childhood maltreatment, greater impulsivity, perceiving one's local community or neighborhood to be unsafe, and having a larger number of criminally involved friends. Conclusions. Drinking-related problems were prevalent in this population. Numerous factors underlie the extent to which African American women experienced problems resulting from their alcohol use. There is strong evidence of syndemic-type effects influencing drinking problems in this population, and future efforts to reduce the negative impact of alcohol (ab)use ought to consider the adoption of programs using a syndemics' theory approach.
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McDonell MG, Nepom JR, Leickly E, Suchy-Dicey A, Hirchak K, Echo-Hawk A, Schwartz SM, Calhoun D, Donovan D, Roll J, Ries R, Buchwald D. A culturally-tailored behavioral intervention trial for alcohol use disorders in three American Indian communities: Rationale, design, and methods. Contemp Clin Trials 2016; 47:93-100. [PMID: 26706667 PMCID: PMC4818164 DOI: 10.1016/j.cct.2015.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Disproportionately high rates of alcohol use disorders are present in many American Indian/Alaska Native (AI/AN) communities, yet little information exists regarding the effectiveness of alcohol treatments in AI/AN populations. Contingency management is an intervention for illicit drug use in which tangible reinforcers (rewards) are provided when patients demonstrate abstinence as assessed by urine drug tests. Contingency management has not been widely studied as an intervention for alcohol problems because until recently, no alcohol biomarker has been available to adequately verify abstinence. AIMS The HONOR Study is designed to determine whether a culturally-tailored contingency management intervention is an effective intervention for AI/AN adults who suffer from alcohol use disorders. METHODS Participants include 400 AI/AN alcohol-dependent adults residing in one rural reservation, one urban community, as well as a third site to be decided, in the Western U.S. Participants complete a 4-week lead-in phase prior to randomization, then 12 weeks of either a contingency management intervention for alcohol abstinence, or a control condition where participants receive reinforcers for attending study visits regardless of alcohol use. Participants are then followed for 3-more months post-intervention. The primary study outcome is urinary ethyl glucuronide-confirmed alcohol abstinence; secondary outcomes include self-reported alcohol and drug use, HIV risk behaviors, and self-reported cigarette smoking. DISCUSSION This will be the largest randomized, controlled trial of any alcohol for AI/ANs and the largest contingency management study targeting alcohol use disorders, thus providing important information to AI/AN communities and the alcohol treatment field in general.
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Affiliation(s)
- Michael G McDonell
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA; Elson S Floyd College of Medicine, Washington State University, USA
| | - Jenny R Nepom
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA
| | - Emily Leickly
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA
| | - Astrid Suchy-Dicey
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA
| | - Kait Hirchak
- Department of Health Policy and Administration, Washington State University, Spokane, WA 99210-1495, USA
| | - Abigail Echo-Hawk
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA
| | - Stephen M Schwartz
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA; Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109-1024, USA
| | - Darren Calhoun
- Med Star Health Research Institute, 1616 E. Indian School Rd., Phoenix, AZ 85016, USA
| | - Dennis Donovan
- Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - John Roll
- Washington State University, Spokane, WA 99210-1495, USA
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Dedra Buchwald
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA; Elson S Floyd College of Medicine, Washington State University, USA
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Prendergast ML, Hall EA, Grossman J, Veliz R, Gregorio L, Warda US, Van Unen K, Knight C. Effectiveness of Using Incentives to Improve Parolee Admission and Attendance in Community Addiction Treatment. CRIMINAL JUSTICE AND BEHAVIOR 2015; 42:1008-1031. [PMID: 28331241 PMCID: PMC5358665 DOI: 10.1177/0093854815592914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study is a randomized effectiveness trial of the use of incentives to improve treatment utilization among parolees in community treatment. In prison, Admission phase parolees were randomized to Admission Incentive (N=31) or Education (N=29). Attendance phase parolees entering community treatment were randomized to Attendance Incentive (N=104) or Education (N=98). There was no main effect for incentives in either study phase. Neither admission to community treatment (Incentive 60%, Education 64%; p =.74), nor intervention completion (Incentive 22%; Education 27%; p =.46) appeared to be impacted. Time-in-treatment was predicted by age, first arrest age, and type of parole status (Cox regression p<.05), but not by treatment group. Providing incentives did not increase the likelihood that parolees enrolled in or stayed in community treatment. In light of this finding, criminal justice practitioners who are considering incentives to increase admission or retention should be aware that they may not produce the desired outcomes.
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Montgomery L, Carroll KM, Petry NM. Initial abstinence status and contingency management treatment outcomes: does race matter? J Consult Clin Psychol 2015; 83:473-81. [PMID: 25798729 DOI: 10.1037/a0039021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Limited research has evaluated African American substance users' response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. METHOD A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. RESULTS African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. CONCLUSIONS CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed.
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Affiliation(s)
- LaTrice Montgomery
- Mental Health and Substance Abuse Counseling Program, School of Human Services, University of Cincinnati
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System
| | - Nancy M Petry
- Department of Medicine, University of Connecticut Health Center
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Milward J, Lynskey M, Strang J. Solving the problem of non-attendance in substance abuse services. Drug Alcohol Rev 2014; 33:625-36. [PMID: 25196817 DOI: 10.1111/dar.12194] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 07/15/2014] [Indexed: 11/29/2022]
Abstract
ISSUES Rates of non-attendance are among the highest in substance misuse services. Non-attendance is costly and results in the inefficient use of limited resources. Patients who frequently miss their appointments have worse outcomes including treatment dropout and decreased likelihood of achieving long-term abstinence. APPROACH This narrative review evaluates interventions targeting non-attendance in addiction services and draws upon the wider health-care literature to identify interventions that could be adapted for substance-abusing populations. KEY FINDINGS Both fixed value and intermittent reinforcement contingency management demonstrate potential for improving attendance. However, small sample sizes and heterogeneous populations make it difficult to draw firm conclusions. Appointment reminders by letter or telephone have demonstrated moderate evidence for improving attendance in substance-abusing populations. Text message appointment reminders are extensively utilised in general health-care settings and consistently improve attendance; however, there is a paucity of research examining the feasibility and effectiveness of text message reminders in addiction services. IMPLICATIONS A lack of evidence for methods to improve attendance is reflected in the continuing challenge faced by addiction services attempting to manage high rates of non-attendance. CONCLUSIONS Non-attendance remains a persistent issue for addiction services. While there is limited evidence that contingency management improves attendance, more rigorous research is needed to determine the optimal intervention components and effectiveness in different populations, particularly those receiving maintenance treatments. Multicomponent text message interventions incorporating different delivery and content strategies demonstrate a promise for improving non-attendance and poor engagement.
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Affiliation(s)
- Joanna Milward
- Institute of Psychiatry, King's College London, London, UK
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McKay JR, Van Horn DHA, Lynch KG, Ivey M, Cary MS, Drapkin ML, Coviello DM, Plebani JG. An adaptive approach for identifying cocaine dependent patients who benefit from extended continuing care. J Consult Clin Psychol 2013; 81:1063-73. [PMID: 24041231 DOI: 10.1037/a0034265] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Study tested whether cocaine dependent patients using cocaine or alcohol at intake or in the first few weeks of intensive outpatient treatment would benefit more from extended continuing care than patients abstinent during this period. The effect of incentives for continuing care attendance was also examined. METHOD Participants (N = 321) were randomized to treatment as usual (TAU), TAU and telephone monitoring and counseling (TMC), or TAU and TMC plus incentives (TMC+). The primary outcomes were (a) abstinence from all drugs and heavy alcohol use and (b) cocaine urine toxicology. Follow-ups were at 3, 6, 9, 12, 18, and 24 months. RESULTS Cocaine and alcohol use at intake or early in treatment predicted worse outcomes on both measures (ps ≤ .0002). Significant effects favoring TMC over TAU on the abstinence composite were obtained in participants who used cocaine (odds ratio [OR] = 1.95 [1.02, 3.73]) or alcohol (OR = 2.47 [1.28, 4.78]) at intake or early in treatment. A significant effect favoring TMC+ over TAU on cocaine urine toxicology was obtained in those using cocaine during that period (OR = 0.55 [0.31, 0.95]). Conversely, there were no treatment effects in participants abstinent at baseline and no overall treatment main effects. Incentives almost doubled the number of continuing care sessions received but did not further improve outcomes. CONCLUSION An adaptive approach for cocaine dependence in which extended continuing care is provided only to patients who are using cocaine or alcohol at intake or early in treatment improves outcomes in this group while reducing burden and costs in lower risk patients.
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Affiliation(s)
- James R McKay
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
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Davis TA, Ancis J. Look to the relationship: a review of African American women substance users' poor treatment retention and working alliance development. Subst Use Misuse 2012; 47:662-72. [PMID: 22329365 DOI: 10.3109/10826084.2012.654882] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Emergent findings specific to African American women confirm that their substance user treatment retention rates are significantly lower than other groups, which is problematic given that substance user treatment is effective largely to the extent that clients are retained in treatment. This article reviews existing literature concerning disparities in treatment retention, highlights a significant barrier to treatment retention for this population, and presents support for an empirical focus on culturally responsive working alliance development as a promising step toward improving retention rates for African American women substance users.
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Affiliation(s)
- Telsie A Davis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
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Trenz R, Penniman T, Scherer M, Zur J, Rose J, Latimer W. Problem recognition, intention to stop use, and treatment use among regular heroin injectors. J Subst Abuse Treat 2012; 43:204-10. [PMID: 22301081 DOI: 10.1016/j.jsat.2011.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 11/16/2011] [Accepted: 12/12/2011] [Indexed: 11/18/2022]
Abstract
This study investigated frequency of recent use as an explanatory variable in problem recognition and intention to stop use among regular injection heroin users. Data from the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors for HIV and hepatitis A, B, and C among injection and noninjection drug users, were used in the analyses. Participants (N = 337) consisted of those who reported injecting heroin daily or nearly daily for a period of 3 months. Multiple linear regression analysis revealed that frequency of recent injection drug use predicted problem recognition (β = .17), but not intention to stop use; although marginal, being female (β = .15), and homeless (β = .14) contributed to intention to stop use. Past 6-month treatment participation was 48%, and current treatment enrollment was 26% among study participants. This study highlights the importance of capitalizing on injection drug users' recent use as a mechanism for treatment interventions.
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Affiliation(s)
- Rebecca Trenz
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Voucher incentives increase treatment participation in telephone-based continuing care for cocaine dependence. Drug Alcohol Depend 2011; 114:225-8. [PMID: 21041041 PMCID: PMC3046319 DOI: 10.1016/j.drugalcdep.2010.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 09/03/2010] [Accepted: 09/07/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Telephone-based monitoring is a promising approach to continuing care of substance use disorders, but patients often do not engage or participate enough to benefit. Voucher incentives can increase retention in outpatient treatment and continuing care, but may be less effective when reinforcement is delayed, as in telephone-based care. We compared treatment utilization rates among cocaine-dependent patients enrolled in telephone continuing care with and without voucher incentives to determine whether incentives increase participation in telephone-based care. METHOD Participants were 195 cocaine-dependent patients who completed two weeks of community-based intensive outpatient treatment for substance use disorders and were randomly assigned to receive telephone continuing care with or without voucher incentives for participation as part of a larger clinical trial. The 12-month intervention included 2 in-person orientation sessions followed by up to 30 telephone sessions. Incentivized patients could receive up to $400 worth of gift cards. RESULTS Patients who received incentives were not more likely to complete their initial orientation to continuing care. Incentivized patients who completed orientation completed 67% of possible continuing care sessions, as compared to 39% among non-incentivized patients who completed orientation. Among all patients randomized to receive incentives, the average number of completed sessions was 15.5, versus 7.2 for patients who did not receive incentives, and average voucher earnings were $200. CONCLUSIONS Voucher incentives can have a large effect on telephone continuing care participation, even when reinforcement is delayed. Further research will determine whether increased participation leads to better outcome among patients who received incentives.
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