Monetary alternative reinforcers more effectively decrease intranasal cocaine choice than food alternative reinforcers
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Contingency management
Self-administration
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Context: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings.Objective: To evaluate the efficacy of an abstinencebased contingency management intervention as an addition to usual care in community treatment settings.Design: Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks.Setting: Eight community-based outpatient psychosocial drug abuse treatment programs.Participants: A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment.Intervention: All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent.Main Outcome Measures: Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant-and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence.Results: Participants assigned to the abstinence-based incentive condition remained in treatment for a mean±SD of 8.0±4.2 weeks and attended a mean±SD of 19.2±16.8counseling sessions compared with 6.9±4.4 weeks and 15.7±14.4sessions for those assigned to the usual care condition (PϽ.02 for all).Participants in the abstinencebased incentive condition also submitted significantly more stimulant-and alcohol-free samples (PϽ.001).The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively.However, the percentage of positive samples submitted was low overall and did not differ between conditions. Conclusion:The abstinence-based incentive procedure, which provided a mean of $203 in prizes per participant, was efficacious in improving retention and associated abstinence outcomes.
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Contingency management (CM) interventions usually reinforce submission of drug-negative specimens, but they can also reinforce adherence with goal-related activities. This study compared the efficacy of the 2 approaches. Substance-abusing outpatients (N = 131) were randomly assigned to 1 of 3 12-week treatments: standard treatment (ST), ST with CM for submitting negative urine toxicology screens, or ST with CM for completing goal-related activities. CM patients remained in treatment longer and achieved more abstinence than ST patients, but the CM condition that reinforced submission of negative samples resulted in better outcomes than the CM condition that reinforced goal-related activities. Abstinence at 6- and 9-month follow-ups did not differ by group, but longest duration of abstinence achieved during treatment was associated with abstinence posttreatment.
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Two males diagnosed with cocaine dependence received a behavioral intervention comprised of contingency management and the community reinforcement approach. During the initial phase of treatment, reinforcement was delivered contingent on submitting cocaine‐free urine specimens. The community reinforcement approach involved two behavior therapy sessions each week. Almost complete cocaine abstinence was achieved, but regular marijuana use continued. During a second phase, reinforcement magnitude was reduced, but remained contingent on submitting cocaine‐free specimens. Behavior therapy was reduced to once per week. Cocaine abstinence and regular marijuana use continued. Next, reinforcement was delivered contingent on submitting cocaine‐ and marijuana‐free specimens. This modified contingency resulted in an abrupt increase in marijuana abstinence and maintenance of cocaine abstinence. One‐ and 5‐month follow‐ups indicated that cocaine abstinence continued, but marijuana smoking resumed. These results indicate that the behavioral intervention was efficacious in achieving abstinence from cocaine and marijuana; maintenance, however, was achieved for cocaine only.
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This study analyzed whether a contingency management (CM) for shaping cessation period implemented prior to an abstinence-only period (CMS) improves outcomes relative to CM that reinforces only a fixed abstinence criteria (CMA) among treatment-seeking patients in a community setting. A total of 110 patients were randomly assigned to 1 of 2 treatment conditions: CMA (N = 55) or CMS (N = 55). All participants received cognitive-behavioral treatment (CBT) implemented in 6 group-based sessions. CMA participants earned voucher-based incentives contingent on providing biochemical evidence of smoking abstinence. CMS reinforced closer approximations to smoking abstinence. At posttreatment, patients assigned to the CMA group achieved the same rates of smoking abstinence (point-prevalence) as those in the CMS group (94.5%; p > .05). At the 6-month follow-up, 43.6% of the patients who received CMA maintained smoking abstinence in comparison to 32.7% in the CMS group (p > .05). At the 12-month follow-up, 40% of the participants assigned to the CMA group were abstinent, in comparison to 29.1% who received CMS (p > .05). There were no statistically significant differences in continuous smoking abstinence between the treatment conditions in any of the follow-ups (p > .05). These results offer a novel contribution by suggesting that CM was associated with enduring effects up to 12 months after the end of treatment and that CM for shaping cessation period implemented prior to an abstinence-only period (CMS) improves outcomes relative to CM that reinforces only a fixed abstinence criteria (CMA) among treatment-seeking patients in a community setting. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Day treatment with contingency management for cocaine abuse in homeless persons: 12-month follow-up.
Abstinence, employment, and homelessness treatment outcomes at 12-month follow-up are presented from a study comparing behavioral day treatment plus abstinence-contingent housing and work therapy with behavioral day treatment only among homeless persons who abuse crack cocaine. Within-group improvements were revealed, but group differences for drug abstinence found in J. B. Milby et al. (2000) failed to persist at 12 months. Drug use measurement and treatment termination explanations are discussed. Within- but not between-group differences were found for employment and homelessness outcomes at long-term follow-up. Research extending abstinence contingencies and continuous drug use monitoring is recommended. Questions about effectiveness of contingency management alone, role of coexisting psychiatric disorders on treatment outcome, and individualized treatment dosing are offered.
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The present study evaluated a new 30-day Web-based contingency management program for smoking abstinence with 4 daily-smoking adolescents. Participants made 3 daily video recordings of themselves giving breath carbon monoxide (CO) samples at home that were sent electronically to study personnel. Using a reversal design, participants could earn money for continued abstinence during the treatment phases (CO < or =5 ppm). All participants were compliant with the treatment (submitting 97.2% of samples), and all achieved prolonged abstinence from smoking.
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Contingency management (CM) treatments enhance drug abstinence. This study evaluated whether CM also improves quality of life and if these effects are mediated by abstinence. Across 3 independent trials, cocaine abusers in intensive outpatient treatment (n = 387) were randomly assigned to 12 weeks of standard treatment as usual or standard treatment with CM. The Quality Of Life Inventory (QOLI) was administered at baseline and at Months 1, 3, 6, and 9. Changes in QOLI scores over time differed significantly by treatment, with QOLI scores rising over time in CM participants and remaining stable in standard treatment participants. CM participants also achieved greater durations of abstinence, and duration of abstinence was correlated with posttreatment QOLI scores. During-treatment abstinence mediated the relationship between treatment condition and QOLI scores over time.
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Vouchers Versus Prizes: Contingency Management Treatment of Substance Abusers in Community Settings.
Contingency management (CM) interventions usually use vouchers as reinforcers, but a new technique awards chances of winning prizes. This study compares these approaches. In community treatment centers, 142 cocaine- or heroin-dependent outpatients were randomly assigned to standard treatment (ST), ST with vouchers, or ST with prizes for 12 weeks. CM patients remained in treatment longer and achieved greater durations of objectively confirmed abstinence than did ST patients; CM conditions did not differ significantly. Although abstinence at 6- and 9-month follow-ups did not differ by group, the best predictor of abstinence was longest duration of abstinence achieved during treatment. Thus, prize and voucher CM systems are equally efficacious in promoting long durations of abstinence, which in turn are associated with benefits posttreatment.
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Cocaine-using methadone-maintenance patients were randomized to standard contingency management (abstinence group, n = 49) or to a contingency designed to increase contact with reinforcers (shaping group, n = 46). For 8 weeks, both groups earned escalating-value vouchers based on thrice-weekly urinalyses: The abstinence group earned vouchers for cocaine-negative urines only; the shaping group earned vouchers for each urine specimen with a 25% or more decrease in cocaine metabolite (first 3 weeks) and then for negative urines only (last 5 weeks). Cocaine use was lower in the shaping group, but only in the last 5 weeks, when the response requirement was identical. Thus, the shaping contingency appeared to better prepare patients for abstinence. A 2nd phase of the study showed that abstinence induced by escalating-value vouchers can be maintained by a nonescalating schedule, suggesting that contingency management can be practical as a maintenance treatment.
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Contingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence.A total of 80 participants (75.8% males; Mage = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence.Adding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488).CM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.
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