Incentive-Based Therapy Improves Outlook For
Methamphetamine Abusers
New research suggests that offering methamphetamine abusers an
incentive-based behavioral therapy program called contingency management
(CM — also known as Motivational Incentives), along with
psychosocial therapy is more effective than psychosocial therapy
alone. The study was supported by the National Institute on Drug
Abuse (NIDA), National Institutes of Health, and is published in
the November 2006 issue of the American Journal of Psychiatry.
A CM program applies rules and consequences to help people change
their behavior. In other words, participants are in treatment with
contingencies, or rewards. In this case, the rules required production
of drug-free urine samples. The rewards were plastic chips that
could be exchanged for prizes. Other examples of CM awards might
be raffle tickets, or small prizes that could be exchanged for
a larger prize. The more the patient follows the rules, the more
chips they earn. If the rules are not followed, they can lose chips.
Previous studies have shown the effectiveness of CM as a treatment
for stimulant abuse (primarily cocaine). This most recent study
suggests that CM can help methamphetamine abusers to stop or reduce
their abuse of the drug for a longer time than individuals who
receive the standard treatment as usual but do not receive such
incentives, or rewards.
“Methamphetamine abuse is associated with numerous medical consequences,
such as rapid, irregular heartbeat, stroke, severe dental problems,
psychosis, and addiction, and constitutes one of the nation’s most
serious public health problems,” says Dr. Elias A. Zerhouni, director
of the National Institutes of Health. “The results of this study
are an important step toward developing more effective therapies
to combat it.”
“This study represents the first controlled trial of CM in the
treatment of methamphetamine abuse,” says NIDA Director Dr. Nora
D. Volkow. “This gives treatment providers another tool to help
methamphetamine addicts.”
Lead scientist Dr. John Roll, of Washington State University,
and his colleagues observed that participants who received CM plus
treatment as usual submitted significantly more substance-free
urine samples than participants who received only usual treatment
during the 12-week study. “Similarly, participants who were part
of the CM program were continuously abstinent for almost five weeks,
while those who received the usual treatment documented continuous
abstinence for less than three weeks,” he says.
This study was conducted through NIDA’s National Drug Abuse Clinical
Trials Network, a research-based infrastructure that tests the
effectiveness of new and improved interventions in community-based
treatment settings among diverse populations. All participants
underwent psychosocial therapy and were randomized to receive either
additional CM treatment or no additional treatment.
At the clinic with the largest proportion of participants, usual
care consisted of the Matrix Model of psychosocial treatment, a
comprehensive treatment approach including individual counseling,
cognitive behavioral therapy, family education, self-help programs,
and monitoring for drug use by urine testing. At the other clinics,
treatment was a mix of cognitive behavioral therapy and relapse
prevention. Cognitive behavioral therapy seeks to identify distorted
thinking that influences mood and behavior and to replace it with
more rational, adaptive thoughts and actions. Relapse prevention
is a strategy that trains drug abusers to overcome the stressors
or triggers in their environments that may cause relapse into drug
abuse and addiction.
“The Matrix Model of psychosocial treatment currently is thought
to be the most effective therapy for methamphetamine addiction,” says
Dr. Volkow. “And CM has shown itself to increase the therapeutic
effectiveness of treatments for other drug abuse disorders. Combining
these two treatments gives us an even more powerful weapon against
methamphetamine abuse.”
The National Institute on Drug Abuse is a component of the
National Institutes of Health, U.S. Department of Health and
Human Services. NIDA supports most of the world’s research on
the health aspects of drug abuse and addiction. The Institute
carries out a large variety of programs to ensure the rapid dissemination
of research information and its implementation in policy and
practice. Fact sheets on the health effects of drugs of abuse
and information on NIDA research and other activities can be
found on the NIDA home page at www.drugabuse.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov. |