Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study.
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.
Peirce
Jessica M
JM
Mid Atlantic Node, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. jmpeirce@jhmi.edu
Petry
Nancy M
NM
Stitzer
Maxine L
ML
Blaine
Jack
J
Kellogg
Scott
S
Satterfield
Frank
F
Schwartz
Marion
M
Krasnansky
Joe
J
Pencer
Eileen
E
Silva-Vazquez
Lolita
L
Kirby
Kimberly C
KC
Royer-Malvestuto
Charlotte
C
Roll
John M
JM
Cohen
Allan
A
Copersino
Marc L
ML
Kolodner
Ken
K
Li
Rui
R
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
D000701:Analgesics, Opioid; D000697:Central Nervous System Stimulants; D000431:Ethanol; D008691:Methadone