|
BACKGROUND/RATIONALE:
Substance use disorders (SUDs) produce enormous morbidity and mortality and are very costly to the VA. This study will investigate the incremental effectiveness of adding a contingency management (CM) intervention to standard SUD treatment. Previous research from multiple investigators has demonstrated the efficacy of CM interventions for reducing substance use and increasing treatment attendance and retention. However, only one small study with alcohol dependent VA patients has demonstrated the effectiveness of CM interventions in the VA patient population. Only two non-VA studies have demonstrated increased cocaine abstinence as long as 6 and 12 months following a CM intervention. We propose a two-site randomized effectiveness trial of CM interventions to improve outcomes over 1 year follow up among veterans with alcohol and/or stimulant dependence. Because CM poses unique challenges to broad implementation within VA (e.g., concerns related to the use of clinical funds for incentives and negative reactions to "paying people to get better"), such a trial is a necessary step to help address these barriers and move toward implementation.
OBJECTIVE(S):
The objectives of this study are to compare differences between Usual Care alone and Usual Care plus Contingency Management on participants:
1. Urine drug and breath alcohol screens over an 8-week intervention period,
2. Rates of attendance at SUD treatment appointments during the 8-week intervention period, and
3. Self-reported percent days abstinent during the prior 30 days at two, six, and 12 month follow-up interviews.
METHODS:
Design: randomized, controlled trial
Participants and Setting: 360 veterans presenting for specialty SUD treatment at the VAMCs in Minneapolis or Seattle. Minimal exclusion criteria include screening positive for gambling problems, active psychoses or suicidal risk.
Research Methods: Randomization will be stratified by site and primary SUD (alcohol or stimulant). Participants will be assigned to 8-weeks of Usual Care or Usual Care plus Contingency Management and will meet with a research assistant twice/week to submit urine and breath samples. Follow-up assessments occur 2, 6 and 12 months after enrollment into the study.
Intervention: Participants randomized to the CM intervention can draw tokens (with replacement) from a bowl each time they submit negative urine and breath screens. The number of draws escalates with continued weeks of negative screens or returns to baseline if screens are missed or negative. Half the 500 tokens will result in social reinforcement ("Good Job!"). The remainder earn a VA canteen voucher worth $1 (209 of 500), $20 (40 of 500) or $80 (1 of 500).
Primary outcome measures: Number of days with negative urine drug and breath alcohol screens during the intervention phase, days of treatment attendance during the intervention phase, and percent days abstinent on the Timeline Follow-Back interview at follow-up assessments. Secondary outcomes include a brief assessment of employment, housing, legal, and psychiatric status, and administrative data on VA service utilization. A process evaluation and an economic analysis are included.
FINDINGS/RESULTS:
No findings to report at this time.
IMPACT:
This trial will determine the effectiveness of adding a Contingency Management intervention to standard SUD treatment for alcohol and stimulant dependence within the VA. In addition to data on extended outcome effects, this trial will provide the research team and participating clinic staff with experience in the process and barriers of establishing CM interventions in VA SUD treatment clinics and will inform future implementation and dissemination efforts.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Substance Abuse, Addictive Disorders
DRE:
Resource Use and Cost
Keywords:
Alcohol, Behavior (patient), Drug abuse
MeSH Terms:
none
|
