title: A randomized trial of contingency management delivered by community therapists.
abstract: OBJECTIVE
  Contingency management (CM) is an evidence-based treatment, but few clinicians deliver this intervention in community-based settings.
  
  
  METHODS
  Twenty-three clinicians from 3 methadone maintenance clinics received training in CM. Following a didactics seminar and a training and supervision period in which clinicians delivered CM to pilot patients, a randomized trial evaluated the efficacy of CM when delivered entirely by clinicians. Sixteen clinicians treated 130 patients randomized to CM or standard care. In both conditions, urine and breath samples were collected twice weekly for 12 weeks. In the CM condition, patients earned the opportunity to win prizes ranging in value from $1 to $100 for submitting samples negative for cocaine and alcohol. Primary treatment outcomes were retention, longest continuous period of abstinence, and proportion of negative samples submitted.
  
  
  RESULTS
  Patients randomized to CM remained in the study longer (9.5 ± 3.6 vs. 6.7 ± 5.0 weeks), achieved greater durations of abstinence (4.7 ± 4.7 vs. 1.7 ± 2.7 weeks), and submitted a higher proportion of negative samples (57.7% ± 40.0% vs. 29.4% ± 33.3%) than those assigned to standard care.
  
  
  CONCLUSIONS
  These data indicate that, with appropriate training, community-based clinicians can effectively administer CM. This study suggests that resources ought to be directed toward training and supervising community-based providers in delivering CM, as patient outcomes can be significantly improved by integrating CM in methadone clinics.
authors.affiliation: Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT 06030-3944, USA. npetry@uchc.edu
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Petry
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Alessi
authors.forename: David M
authors.initials: DM
authors.lastname: Ledgerwood
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000628:therapy*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010865:Pilot Projects; D012054:Reinforcement, Psychology; D016896:Treatment Outcome