title: Behavioral contingencies improve counseling attendance in an adaptive treatment model.
abstract: Poor patient adherence remains a serious obstacle to improving the effectiveness of many drug abuse therapies and the overall quality of care delivered in programs. The present study evaluated the utility and efficacy of incorporating behavioral contingencies in a stepped care treatment approach to motivate patient attendance to the varying amounts of prescribed weekly counseling. Study participants were opioid-dependent patients (n = 127) newly admitted to an ambulatory treatment program that provides methadone. Participants were randomly assigned to a Motivated Stepped Care condition (MSC; n = 65) with behavioral contingencies to specifically motivate counseling attendance vs. a Standard Stepped Care condition (SSC; n = 62) without these contingencies. The MSC vs. SSC condition was associated with a higher rate of counseling attendance (83% vs. 44%, p < .001) and a lower rate of poor treatment response (46% vs. 79%, p < .001). The behavioral contingencies were well tolerated and strongly associated with excellent attendance across both lower and higher doses of weekly counseling.
authors.affiliation: The Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center Baltimore, MD 21224, USA. rkbrooner@aol.com
authors.forename: Robert K
authors.initials: RK
authors.lastname: Brooner
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kidorf
authors.forename: Van L
authors.initials: VL
authors.lastname: King
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Stoller
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Peirce
authors.forename: George E
authors.initials: GE
authors.lastname: Bigelow
authors.forename: Ken
authors.initials: K
authors.lastname: Kolodner
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D000553:Ambulatory Care; D015142:Baltimore; D001521:Behavior Therapy / Q000379:methods*; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D015897:Comorbidity; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009042:Motivation; D009293:Opioid-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D015813:Substance Abuse Detection / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000523:psychology*; D014505:Urban Population
chemical_list: D013287:Illicit Drugs; D008691:Methadone