title: Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial.
abstract: BACKGROUND
  The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program.
  
  
  METHODS
  Opioid-dependent outpatients (n=125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.00) contingent on full adherence to each week of scheduled psychiatric services; or (2) standard on-site integrated care (SOIC). All participants received access to the same schedule of psychiatrist and mental health counseling sessions for 12-weeks.
  
  
  RESULTS
  ROIC participants attended more overall psychiatric sessions at month 1 (M=7.53 vs. 3.97, p<.001), month 2 (M=6.31 vs. 2.81, p<.001), and month 3 (M=5.71 vs. 2.44, p<.001). Both conditions evidenced reductions in psychiatric distress (p<.001) and similar rates of drug-positive urine samples. No differences in study retention were observed.
  
  
  CONCLUSIONS
  These findings suggest that contingency management can improve utilization of psychiatric services scheduled within an on-site and integrated treatment model. Delivering evidenced-based mental health counseling, or modifying the contingency plan to include illicit drug use, may be required to facilitate greater changes in psychiatric and substance abuse outcomes.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, United States. Electronic address: mkidorf@jhmi.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Kidorf
authors.forename: Robert K
authors.initials: RK
authors.lastname: Brooner
authors.forename: Neeraj
authors.initials: N
authors.lastname: Gandotra
authors.forename: Denis
authors.initials: D
authors.lastname: Antoine
authors.forename: Van L
authors.initials: VL
authors.lastname: King
authors.forename: Jessica
authors.initials: J
authors.lastname: Peirce
authors.forename: Sharon
authors.initials: S
authors.lastname: Ghazarian
mesh_terms: D000328:Adult; D003376:Counseling; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration*; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012054:Reinforcement, Psychology; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*
keywords: Contingency management; Methadone maintenance; Psychiatric comorbidity; Treatment adherence