Contingency Management Abstinence Incentives: Cost and Implications for Treatment Tailoring.
To examine prize-earning costs of contingency management (CM) incentives in relation to participants' pre-study enrollment drug use status (baseline (BL) positive vs. BL negative) and relate these to previously reported patterns of intervention effectiveness.



Participants were 255 substance users entering outpatient treatment who received the therapeutic educational system (TES), in addition to usual care counseling. TES included a CM component such that participants could earn up to $600 in prizes on average over 12-weeks for providing drug negative urines and completing web-based cognitive behavior therapy modules. We examined distribution of prize draws and value of prizes earned for subgroups that were abstinent (BL negative; N=136) or not (BL positive; N=119) at study entry based on urine toxicology and breath alcohol screen.



Distribution of draws earned (median=119 vs. 17; p<.0001) and prizes redeemed (median=54 vs. 9; p<.001) for drug abstinence differed significantly for BL negative compared to BL positive participants. BL negative earned on average twice as much in prizes as BL positive participants ($245 vs. $125). Median value of prizes earned was 5.4 times greater for BL negative compared to BL positive participants ($237 vs. $44; p<.001).



Two-thirds of expenditures in an abstinence incentive program were paid to BL negative participants. These individuals had high rates of drug abstinence during treatment and did not show improved abstinence outcomes with TES versus usual care (Campbell et al., 2014). Effectiveness of the abstinence-focused CM intervention included in TES may be enhanced by tailoring delivery based on patients' drug use status at treatment entry.
Johns Hopkins University School of Medicine, Department of Psychiatry.
Colin
C
Cunningham
Johns Hopkins University School of Medicine, Department of Psychiatry. Electronic address: mstitzer@jhmi.edu.
Maxine
M
Stitzer
Columbia University Department of Psychiatry and New York State Psychiatric Institute.
Aimee N C
AN
Campbell
Columbia University Mailman School of Public Health Department of Biostatistics.
Martina
M
Pavlicova
Columbia University Department of Psychiatry and New York State Psychiatric Institute.
Mei-Chen
MC
Hu
Columbia University Department of Psychiatry and New York State Psychiatric Institute.
Edward V
EV
Nunes
D000328:Adult; D001521:Behavior Therapy / Q000191:economics* / Q000379:methods; D003376:Counseling / Q000191:economics* / Q000379:methods; D006801:Humans; D009042:Motivation; D017063:Outcome Assessment, Health Care; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods; D012201:Reward; D019966:Substance-Related Disorders / Q000191:economics / Q000628:therapy*
Baseline drug use; Contingency management; Incentive costs; Treatment tailoring