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Effect of Prize-Based Incentives on Outcomes in Stimulant Abusers in Outpatient Psychosocial Treatment Programs
A National Drug Abuse Treatment Clinical Trials Network Study
Nancy M. Petry, PhD;
Jessica M. Peirce, PhD;
Maxine L. Stitzer, PhD;
Jack Blaine, MD;
John M. Roll, PhD;
Allan Cohen, MA, MFT;
Jeanne Obert, MS;
Therese Killeen, PhD;
Michael E. Saladin, PhD;
Mark Cowell, BA;
Kimberly C. Kirby, PhD;
Robert Sterling, PhD;
Charlotte Royer-Malvestuto, MEd;
John Hamilton, MFT;
Robert E. Booth, PhD;
Marilyn Macdonald, BA;
Marc Liebert, MA;
Linda Rader, BA;
Raynetta Burns, MA;
Joan DiMaria, MSN;
Marc Copersino, PhD;
Patricia Quinn Stabile, MSW;
Ken Kolodner, ScD;
Rui Li, MS
Arch Gen Psychiatry. 2005;62:1148-1156.
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 abstinence-based 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 ± 16.8 counseling sessions compared with 6.9 ± 4.4 weeks and 15.7 ± 14.4 sessions for those assigned to the usual care condition (P<.02 for all). Participants in the abstinence-based incentive condition also submitted significantly more stimulant- and alcohol-free samples (P<.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.
Author Affiliations: Department of Psychiatry, University of Connecticut School of Medicine, Farmington (Dr Petry); Mid-Atlantic Node, Johns Hopkins University School of Medicine, Baltimore, Md (Drs Peirce, Stitzer, and Kolodner and Mss Quinn Stabile and Li); Biopharmaceutical Research Consultants Inc, Ann Arbor, Mich (Dr Blaine); Washington State University, Tacoma (Dr Roll); Pacific Node, University of California at Los Angeles (Mr Cohen and Ms Obert); South Carolina Node, Medical University of South Carolina, Charleston (Drs Killeen and Saladin and Mr Cowell); Delaware Valley Node, University of Pennsylvania and Treatment Research Institute, Philadelphia (Drs Kirby and Sterling and Ms Royer-Malvestuto); New England Node, Yale University, New Haven, Conn (Mr Hamilton); Rocky Mountain Node, University of Colorado, Denver (Dr Booth; Mss Macdonald, Rader, Burns, and DiMaria; and Mr Liebert); and National Institute on Drug Abuse Intramural Research Program, Baltimore (Dr Copersino).
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