The Effect of a Contingency Management Intervention on Substance Use
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 8/18/2018 |
| Start Date: | May 2007 |
| End Date: | February 2010 |
Effectiveness of Contingency Management in VA Addictions Treatment
Contingency management interventions involve providing a tangible reward for progress toward
treatment goals. The purpose of this study is to determine whether a contingency management
intervention added to usual care leads to improved attendance and decreased substance use in
patients attending outpatient substance use disorders treatment.
treatment goals. The purpose of this study is to determine whether a contingency management
intervention added to usual care leads to improved attendance and decreased substance use in
patients attending outpatient substance use disorders treatment.
Design: This will be a randomized, controlled trial. 360 veterans presenting for specialty
substance use disorders treatment at the Minneapolis VAMC and the VA Puget Sound Health Care
System will be randomly assigned to 8 weeks of Usual Care or Usual Care plus Contingency
Management. Minimal exclusion criteria include primary cannabis dependence, primary opioid
dependence, screening positive for pathological gambling, serious psychiatric symptoms or
suicide risk. Randomization will be stratified by site and primary substance use disorder
(alcohol or stimulant). All participants will meet with a research assistant twice per week
to submit urine drug and breath alcohol samples. Participants randomized to the contingency
management interventions will have the opportunity to draw tokens (with replacement) from a
bowl each time they submit negative urine drug and breath alcohol screens. The number of
drawings allowed escalates with continuous weeks of negative screens or returns to baseline
if screens are positive or missed. Half of the 500 tokens will result in social reinforcement
("Good Job!"). The remainder will earn a VA canteen voucher worth monetary value. Follow-up
assessments occur 2, 6, and 12 months after enrollment into the study. Primary outcomes
measures include number of days with negative urine drug and breath alcohol screens during
the intervention phase, days of treatment attendance during the intervention phase, and
percent days abstinent on the Timeline Follow-Back interview at follow-up assessments.
Secondary outcomes include a brief assessment of employment, housing, legal, and psychiatric
status, and administrative data on VA service utilization. A process evaluation and an
economic analysis are included.
substance use disorders treatment at the Minneapolis VAMC and the VA Puget Sound Health Care
System will be randomly assigned to 8 weeks of Usual Care or Usual Care plus Contingency
Management. Minimal exclusion criteria include primary cannabis dependence, primary opioid
dependence, screening positive for pathological gambling, serious psychiatric symptoms or
suicide risk. Randomization will be stratified by site and primary substance use disorder
(alcohol or stimulant). All participants will meet with a research assistant twice per week
to submit urine drug and breath alcohol samples. Participants randomized to the contingency
management interventions will have the opportunity to draw tokens (with replacement) from a
bowl each time they submit negative urine drug and breath alcohol screens. The number of
drawings allowed escalates with continuous weeks of negative screens or returns to baseline
if screens are positive or missed. Half of the 500 tokens will result in social reinforcement
("Good Job!"). The remainder will earn a VA canteen voucher worth monetary value. Follow-up
assessments occur 2, 6, and 12 months after enrollment into the study. Primary outcomes
measures include number of days with negative urine drug and breath alcohol screens during
the intervention phase, days of treatment attendance during the intervention phase, and
percent days abstinent on the Timeline Follow-Back interview at follow-up assessments.
Secondary outcomes include a brief assessment of employment, housing, legal, and psychiatric
status, and administrative data on VA service utilization. A process evaluation and an
economic analysis are included.
Inclusion Criteria:
- veterans presenting for outpatient substance use disorders treatment with a diagnosis
of alcohol, cocaine, amphetamine, or methamphetamine dependence
Exclusion Criteria:
- primary cannabis dependence
- primary opioid dependence
- severe psychiatric symptoms
- suicide risk
- positive history or screen for pathological gambling
- lacking transportation or living too far away to attend twice per week research
appointments
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