title: Randomized controlled trial of contingency management for stimulant use in community mental health patients with serious mental illness.
abstract: OBJECTIVE
  The primary objective of this study was to determine whether contingency management was associated with increased abstinence from stimulant drug use in stimulant-dependent patients with serious mental illness treated in a community mental health center. Secondary objectives were to determine whether contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV risk behavior, and inpatient service utilization.
  
  
  METHODS
  A randomized controlled design was used to compare outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomly assigned to receive 3 months of contingency management for stimulant abstinence plus treatment as usual or treatment as usual with reinforcement for study participation only. Urine drug tests and self report, clinician-report, and service utilization outcomes were assessed during the 3-month treatment period and the 3-month follow-up period.
  
  
  RESULTS
  Although participants in the contingency management condition were significantly less likely to complete the treatment period than those assigned to the control condition (42% compared with 65%), they were 2.4 times (95% CI=1.9–3.0)more likely to submit a stimulant-negative urine test during treatment. Compared with participants in the control condition,they had significantly lower levels of alcohol use, injection drug use, and psychiatric symptoms and were one-fifth as likely as those assigned to the control condition to be admitted for psychiatric hospitalization during treatment. They also reported significantly fewer days of stimulant drug use during the 3-month follow-up.
  
  
  CONCLUSIONS
  When added to treatment as usual, contingency management is associated with large reductions in stimulant,injection drug, and alcohol use.Reductions in psychiatric symptoms and hospitalizations are important secondary benefits.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA. mikemcd@uw.edu
authors.forename: Michael G
authors.initials: MG
authors.lastname: McDonell
authors.forename: Debra
authors.initials: D
authors.lastname: Srebnik
authors.forename: Frank
authors.initials: F
authors.lastname: Angelo
authors.forename: Sterling
authors.initials: S
authors.lastname: McPherson
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Lowe
authors.forename: Andrea
authors.initials: A
authors.lastname: Sugar
authors.forename: Robert A
authors.initials: RA
authors.lastname: Short
authors.forename: John M
authors.initials: JM
authors.lastname: Roll
authors.forename: Richard K
authors.initials: RK
authors.lastname: Ries
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation; D001714:Bipolar Disorder / Q000523:psychology / Q000534:rehabilitation; D000697:Central Nervous System Stimulants; D003131:Combined Modality Therapy; D003155:Community Mental Health Centers; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010352:Patient Dropouts / Q000523:psychology; D010359:Patient Readmission / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation*; D012008:Recurrence; D012559:Schizophrenia / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D015813:Substance Abuse Detection; D015819:Substance Abuse, Intravenous / Q000523:psychology / Q000534:rehabilitation; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D014040:Token Economy; D014861:Washington
chemical_list: D000697:Central Nervous System Stimulants