title: Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: 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 have improved treatment outcomes of substance abusers, but have not been widely implemented in community drug abuse treatment settings.
  
  
  OBJECTIVE
  To compare outcomes achieved when a lower-cost prize-based contingency management treatment is added to usual care in community methadone hydrochloride maintenance treatment settings.
  
  
  METHODS
  Random assignment to usual care with (n = 198) or without (n = 190) abstinence incentives during a 12-week trial.
  
  
  METHODS
  Six community-based methadone maintenance drug abuse treatment clinics in locations across the United States.
  
  
  METHODS
  Three hundred eighty-eight stimulant-abusing patients enrolled in methadone maintenance programs for at least 1 month and no more than 3 years.
  
  
  METHODS
  Participants submitting stimulant- and alcohol-negative samples earned draws for a chance to win prizes; the number of draws earned increased with continuous abstinence time.
  
  
  METHODS
  Total number of stimulant- and alcohol-negative samples provided, percentage of stimulant- and alcohol-negative samples provided, longest duration of abstinence, retention, and counseling attendance.
  
  
  RESULTS
  Submission of stimulant- and alcohol-negative samples was twice as likely for incentive as for usual care group participants (odds ratio, 1.98; 95% confidence interval, 1.42-2.77). Achieving 4 or more, 8 or more, and 12 weeks of continuous abstinence was approximately 3, 9, and 11 times more likely, respectively, for incentive vs usual care participants. Groups did not differ on study retention or counseling attendance. The average cost of prizes was 120 dollars per participant.
  
  
  CONCLUSIONS
  An abstinence incentive approach that paid 120 dollars in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.
authors.affiliation: Mid Atlantic Node, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. jmpeirce@jhmi.edu
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Peirce
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Petry
authors.forename: Maxine L
authors.initials: ML
authors.lastname: Stitzer
authors.forename: Jack
authors.initials: J
authors.lastname: Blaine
authors.forename: Scott
authors.initials: S
authors.lastname: Kellogg
authors.forename: Frank
authors.initials: F
authors.lastname: Satterfield
authors.forename: Marion
authors.initials: M
authors.lastname: Schwartz
authors.forename: Joe
authors.initials: J
authors.lastname: Krasnansky
authors.forename: Eileen
authors.initials: E
authors.lastname: Pencer
authors.forename: Lolita
authors.initials: L
authors.lastname: Silva-Vazquez
authors.forename: Kimberly C
authors.initials: KC
authors.lastname: Kirby
authors.forename: Charlotte
authors.initials: C
authors.lastname: Royer-Malvestuto
authors.forename: John M
authors.initials: JM
authors.lastname: Roll
authors.forename: Allan
authors.initials: A
authors.lastname: Cohen
authors.forename: Marc L
authors.initials: ML
authors.lastname: Copersino
authors.forename: Ken
authors.initials: K
authors.lastname: Kolodner
authors.forename: Rui
authors.initials: R
authors.lastname: Li
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000534:rehabilitation / Q000652:urine; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000191:economics* / Q000379:methods*; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000652:urine; D000431:Ethanol / Q000652:urine; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009042:Motivation; D009293:Opioid-Related Disorders / Q000209:etiology / Q000534:rehabilitation / Q000652:urine; D012054:Reinforcement, Psychology; D015813:Substance Abuse Detection; D016320:Substance Abuse Treatment Centers / Q000379:methods*; D019966:Substance-Related Disorders / Q000209:etiology / Q000534:rehabilitation* / Q000652:urine; D014040:Token Economy; D016896:Treatment Outcome; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D000697:Central Nervous System Stimulants; D000431:Ethanol; D008691:Methadone