title: Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks.
  
  
  METHODS
  Eight community-based outpatient psychosocial drug abuse treatment programs.
  
  
  METHODS
  A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The abstinence-based incentive procedure, which provided a mean of 203 dollars in prizes per participant, was efficacious in improving retention and associated abstinence outcomes.
authors.affiliation: Department of Psychiatry, University of Connecticut School of Medicine, Farmington, USA. petry@psychiatry.uchc.edu
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Petry
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Peirce
authors.forename: Maxine L
authors.initials: ML
authors.lastname: Stitzer
authors.forename: Jack
authors.initials: J
authors.lastname: Blaine
authors.forename: John M
authors.initials: JM
authors.lastname: Roll
authors.forename: Allan
authors.initials: A
authors.lastname: Cohen
authors.forename: Jeanne
authors.initials: J
authors.lastname: Obert
authors.forename: Therese
authors.initials: T
authors.lastname: Killeen
authors.forename: Michael E
authors.initials: ME
authors.lastname: Saladin
authors.forename: Mark
authors.initials: M
authors.lastname: Cowell
authors.forename: Kimberly C
authors.initials: KC
authors.lastname: Kirby
authors.forename: Robert
authors.initials: R
authors.lastname: Sterling
authors.forename: Charlotte
authors.initials: C
authors.lastname: Royer-Malvestuto
authors.forename: John
authors.initials: J
authors.lastname: Hamilton
authors.forename: Robert E
authors.initials: RE
authors.lastname: Booth
authors.forename: Marilyn
authors.initials: M
authors.lastname: Macdonald
authors.forename: Marc
authors.initials: M
authors.lastname: Liebert
authors.forename: Linda
authors.initials: L
authors.lastname: Rader
authors.forename: Raynetta
authors.initials: R
authors.lastname: Burns
authors.forename: Joan
authors.initials: J
authors.lastname: DiMaria
authors.forename: Marc
authors.initials: M
authors.lastname: Copersino
authors.forename: Patricia Quinn
authors.initials: PQ
authors.lastname: Stabile
authors.forename: Ken
authors.initials: K
authors.lastname: Kolodner
authors.forename: Rui
authors.initials: R
authors.lastname: Li
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000628:therapy / Q000652:urine; D000553:Ambulatory Care; D019969:Amphetamine-Related Disorders / Q000523:psychology / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects / Q000652:urine; D009042:Motivation; D011613:Psychotherapy / Q000379:methods*; D015813:Substance Abuse Detection; D016320:Substance Abuse Treatment Centers / Q000379:methods*; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy* / Q000652:urine; D014040:Token Economy; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine