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McKetin R, Clay S. Virtual contingency management, what is it worth and who will pay for it? Addiction 2024; 119:1517-1518. [PMID: 38752258 DOI: 10.1111/add.16535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 08/03/2024]
Affiliation(s)
- Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Simon Clay
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Khazanov GK, McKay JR, Rawson R. Should contingency management protocols and dissemination practices be modified to accommodate rising stimulant use and harm reduction frameworks? Addiction 2024; 119:1505-1514. [PMID: 38627885 DOI: 10.1111/add.16497] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/15/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND Stimulant-related overdoses have increased dramatically, with almost 50% of overdoses in the United States now involving stimulants. Additionally, harm-reduction approaches are increasingly seen as key to reducing the negative impact of substance use. Contingency management (CM), the provision of financial incentives for abstinence, is the most effective treatment for stimulant use disorder, but historically has not been widely implemented. Many recent, large-scale implementation efforts have relied upon foundational CM protocols that may not sufficiently account for recent increases in the prevalence and lethality of stimulant use nor the growing preference for harm reduction versus abstinence-only frameworks. ARGUMENT We argue the need to (1) consider whether and how CM protocols might be modified to address rising stimulant use and harm reduction frameworks and (2) make CM widely accessible so that it can reduce population-level stimulant use while ensuring that it is delivered with fidelity to its basic principles. Proposed changes include changing CM reinforcement schedules to emphasize treatment engagement and reductions in use in addition to abstinence, changing guidelines on the duration of and re-engagement in CM, investing in research on virtual CM, incentivizing providers and health systems to deliver CM, making it easier to purchase and use point-of-care drug screens, using direct-to-consumer marketing to increase demand for CM and adapting CM to the community in which it is being implemented. CONCLUSIONS Our proposed modifications to contingency management (CM) protocols and accessibility may more effectively address rising stimulant use and align CM more closely with harm-reduction frameworks. Given the urgent need to reduce overdose deaths, developing and testing modified CM protocols may need to rely upon methods other than randomized controlled trials. Efforts to disseminate CM widely to reduce population-level stimulant use must be balanced with the need to maintain fidelity to CM's basic principles.
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Affiliation(s)
- Gabriela Kattan Khazanov
- Center of Excellence for Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - James R McKay
- Center of Excellence for Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Richard Rawson
- University of California Geffen School of Medicine, Los Angeles, CA, USA
- University of Vermont Center for Behavioral Health, Burlington, VT, USA
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Goodwin S, Kirby KC, Raiff BR. Evolution of the substance use landscape: Implications for contingency management. J Appl Behav Anal 2024. [PMID: 39193870 DOI: 10.1002/jaba.2911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024]
Abstract
Contingency management (CM), which involves the delivery of incentives upon meeting behavioral goals, has the potential to improve substance use treatment outcomes. The intervention allows for flexibility through numerous modifiable components including changes to incentive magnitude and schedule, target behavior, and intervention structure. Unfortunately, numerous changes in the substance use landscape have occurred in the past 10 to 15 years: Substances are more potent, overdose risk has increased, new substances and methods of use have been introduced, and substance classes are increasingly being intentionally and unintentionally mixed. These developments potentially undermine CM outcomes. We explored recent substance use changes due to legislative, regulatory, social, and economic factors for four substance classes: stimulants, opioids, tobacco, and cannabis. We discuss potential adjustments to the modifiable components of CM for future research in response to these changes. By continually adapting to the shifting substance use landscape, CM can maintain optimal efficacy.
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Affiliation(s)
- Shelby Goodwin
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA
| | | | - Bethany R Raiff
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA
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Dallery J, Ives L, Knerr A. Toward an era of impact of digital contingency management in the treatment of substance use disorders. Prev Med 2023; 176:107518. [PMID: 37080501 DOI: 10.1016/j.ypmed.2023.107518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 04/22/2023]
Abstract
Digital contingency management entails remote methods to obtain biochemical confirmation of drug status and provide desirable, tangible consequences contingent on abstinence. Advances in digital CM suggest that it may be on the cusp of making a public health impact. Specific advances include technological capabilities and affordability, companies that specialize in digital CM, policies and reimbursement models, and the increasing availability of resources related to CM. Digital CM has expanded from cigarette smoking to alcohol and illicit substance misuse, and to include a diverse range of underserved and high-risk groups (e.g., pregnant and postpartum women, socioeconomically disadvantaged individuals, adolescents, and rural populations). Although the digital divide continues to narrow, culturally responsive methods may increase uptake and engagement with digital CM. The promise of digital CM is widescale access to an evidence-based treatment with low staff burden, no side effects, high fidelity engagement, acceptability, and effectiveness, and greater equity. We may be close to realizing this promise.
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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. Perspectives and sentiments on contingency management from people who use methamphetamine. Drug Alcohol Rev 2023; 42:1427-1437. [PMID: 37248676 DOI: 10.1111/dar.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Contingency management (CM) is currently the most efficacious treatment for methamphetamine use, yet it is rarely available in routine care. We examined the viewpoints of people who use methamphetamine on CM as a potential treatment for methamphetamine use disorder. METHODS Semi-structured qualitative interviews with 30 Australians aged 18 years or older who had used methamphetamine at least weekly in the past 6 months. RESULTS Participants reported overall positive attitudes towards CM as a potential treatment option for methamphetamine use disorder. However, there was need for greater flexibility in meeting participant treatment goals (e.g., reduced use or complete abstinence), with particular concern about the viability of initiating abstinence, both in terms of the sufficiency of the initial financial incentive and managing withdrawal symptoms. There was strong interest in the use of digital technologies to provide remote CM, particularly around the convenience and flexibility this offered. Despite this, participants remained keen to access adjunctive treatment and support services but stressed that engagement with these additional services should not be mandatory. Marketing of CM will need to address preconceptions about drug-testing used in abstinence-based CM being punitive (especially urine testing) and its connotations with criminal justice interventions. DISCUSSION AND CONCLUSION Positive attitudes towards CM bode well for potential uptake should CM be made available in routine clinical practice. However, there is a need to adapt CM to ensure it is feasible and attractive to people who are seeking treatment for methamphetamine use disorder.
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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
| | - Meredith Ginley
- East Tennessee State University, Johnson City, Tennessee, USA
| | - 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
- 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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Ryan-Pettes SR, Morrison M, Randall J, Halliday C, Ledgerwood DM, Cunningham PB. Juvenile Probation Officer Perception of Contingency Management to Target Caregiver Engagement and Training Outcomes. JOURNAL OF OFFENDER REHABILITATION 2023; 62:315-335. [PMID: 38046203 PMCID: PMC10688515 DOI: 10.1080/10509674.2023.2213692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Few community-based substance use treatment programs are available or skilled in treating justice-involved youth, highlighting the need to equip juvenile probation officers with the skills to deliver evidence-based substance use treatment. Contingency management (CM) is evidence-based for treating substance use and shows promise for juvenile probation officers' successful uptake (positive opinions and trainability). However, research has not examined whether probation officers' positive beliefs and trainability generalize to target behaviors beyond those displayed by youth, but that nevertheless affect youth outcomes. This study examined probation officers' perceptions of using CM to engage caregivers and assessed probation officers' CM knowledge and CM delivery after training in a protocol-specific CM program for caregivers of substance-using youth on probation. Results showed probation officers were ambivalent about CM for caregivers. Results also showed that age, training format and how competency is assessed may be essential to consider. Implications for the dissemination of CM and future research are discussed.
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Affiliation(s)
- Stacy R. Ryan-Pettes
- Baylor University, Department of Psychology and Neuroscience, One Bear Place 97334, Waco, Texas 76798
| | - Meghan Morrison
- Baylor University, Department of Psychology and Neuroscience, One Bear Place 97334, Waco, Texas 76798
| | - Jeff Randall
- Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Family Services Research Center, Medical University of South Carolina, 176 Croghan Spur Rd., Ste 104, Charleston, SC 29407
| | - Colleen Halliday
- Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Family Services Research Center, Medical University of South Carolina, 176 Croghan Spur Rd., Ste 104, Charleston, SC 29407
| | - David M. Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Tolan Park, Detroit, MI 48201
| | - Phillippe B. Cunningham
- Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Family Services Research Center, Medical University of South Carolina, 176 Croghan Spur Rd., Ste 104, Charleston, SC 29407
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Getty CA, Weaver T, Metrebian N. A qualitative exploration of patients' experience of mobile telephone-delivered contingency management to promote adherence to supervised methadone. Drug Alcohol Rev 2023; 42:641-651. [PMID: 36269110 DOI: 10.1111/dar.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Despite an increasing evidence base for mobile telephone-delivered contingency management (mCM), there had been no previous qualitative exploration of patients' experience of receiving mCM and the factors that might influence that experience and outcome in a UK setting. The aim of this study was to understand patients' views and experience of receiving mCM by exploring their beliefs, expectations and perceived benefits within the context of the UK's first mCM intervention. METHODS Qualitative interviews (N = 15) were conducted with patients undergoing opioid agonist treatment in a UK drug treatment service and receiving mCM to encourage adherence with supervised methadone as part of an existing study. Interviews were conducted at two time points and analysed using Framework to explore patients' expectations and beliefs during the early stage of the intervention (2 weeks) and their perceived benefits and experience at the end of the intervention (12 weeks). RESULTS The mCM was perceived as a motivator, providing validation of achievement, and involving discreet and positive interactions. Perceived benefits included enhanced methadone adherence, reduced drug use and the development of a supportive and non-judgemental connection that resembled a therapeutic alliance. DISCUSSION AND CONCLUSIONS The mechanisms underpinning contingency management appeared to operate in the absence of human interaction, and the mCM intervention was deemed to be meaningful, acceptable and well received by patients. These findings not only provide support for the application of mCM in this context but also offer insight into the factors that influence outcomes and should be considered in the development of future mCM interventions.
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Affiliation(s)
- Carol-Ann Getty
- National Addiction Centre, King's College London, London, UK
| | - Tim Weaver
- Department of Mental Health and Social Work at Middlesex University, London, UK
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Dorey L, McGarrigle J, May R, Hoon AE, Dymond S. Client Views of Contingency Management in Gambling Treatment: A Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17101. [PMID: 36554983 PMCID: PMC9778966 DOI: 10.3390/ijerph192417101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Low levels of treatment access and poor retention among those with gambling problems suggests a need to improve treatment. Contingency management (CM) is a behavioural intervention involving the identification of target behaviours and the provision of incentives when targets are met. There exists a substantial evidence base for CM increasing abstinence and attendance in substance misuse treatment, but this has not been widely extended to gambling treatment setting. This study sought to explore the views of clients about CM for the treatment of problematic and disordered gambling. We conducted semi-structured interviews with 25 gambling treatment clients who were, or had previously been, engaged in treatment in Great Britain. Participants were provided with an explanation of CM, two hypothetical scenarios, and two structured questionnaires to facilitate discussion. Thematic analysis was used to interpret findings. Some participants felt that clients could manipulate CM while in treatment to obtain money to gamble, and that mechanisms of CM could trigger recovering clients into relapse. Participants also identified potential benefits of CM to achieve treatment goals, by enhancing motivation and engagement while in treatment, and helping bring people into treatment earlier. Gambling treatment clients broadly supported the use of incentives for treatment. CM is seen as a facilitator of extended engagement in treatment, and an encouragement for clients to make progress in the treatment process.
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Affiliation(s)
- Lucy Dorey
- School of Psychology, Swansea University, Singleton Campus, Swansea SA2 8PP, UK
| | - Jack McGarrigle
- School of Psychology, Swansea University, Singleton Campus, Swansea SA2 8PP, UK
| | - Richard May
- School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd CF37 1DL, UK
| | - Alice E. Hoon
- Swansea University Medical School, Singleton Campus, Swansea SA2 8PP, UK
| | - Simon Dymond
- School of Psychology, Swansea University, Singleton Campus, Swansea SA2 8PP, UK
- Department of Psychology, Reykjavík University, Menntavegur 1, Nauthólsvík, 101 Reykjavík, Iceland
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Willingness of people who inject drugs to participate in a randomised controlled trial involving financial incentives to initiate hepatitis C treatment. Drug Alcohol Depend 2022; 235:109438. [PMID: 35430521 DOI: 10.1016/j.drugalcdep.2022.109438] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence regarding the acceptability of contingency management is limited. We investigated the willingness of people who inject drugs to participate in a randomised controlled trial (RCT) involving financial incentives to initiate HCV treatment. METHODS ETHOS Engage is an observational cohort study of people with a history of injecting drug use who either injected in the past six months or receive opioid agonist therapy (OAT) in Australia. We assessed willingness to participate in a RCT with financial incentives and factors associated with preference for entire incentive ($60) at first clinic visit versus delayed incentive with logistic regression. RESULTS 93% (593/635) of eligible participants agreed to participate in an RCT with financial incentives of which 24% were Aboriginal or Torres Strait Islander, 84% had completed secondary school, and 59% injected drugs in the prior month. Willingness to participate in an RCT increased by amount offered: unspecified (72%), $20 (75%), $60 (80%), and $100 (85%). The preferred incentive distribution method over three clinical visits was entire incentive at first clinical visit (32%). Among those with a preferred distribution method (n = 369), factors associated with entire incentive at first clinic visit were being Aboriginal or Torres Strait Islander (aOR 1.75; 95% CI 1.05-2.94), completion of secondary school (aOR 0.46; 95% CI 0.26-0.83) and mainly injected heroin in month prior (aOR 1.82; 95% CI 1.03-3.20). CONCLUSION Most participants were willing to participate in an RCT involving financial incentives to initiate treatment but differed regarding distribution. Study findings inform implementation of incentives in clinical practice.
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