Income does not affect response to contingency management treatments among community substance abuse seekers

Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030-1410, USA.
Drug and alcohol dependence (Impact Factor: 3.42). 08/2009; 104(3):249-53. DOI: 10.1016/j.drugalcdep.2009.05.018
Source: PubMed


The present study examined a commonly held belief that contingency management (CM) may be less effective for substance abusers with relatively more economic resources compared to those with relatively few resources. Using a combined sample of 393 treatment-seeking cocaine abusers from three clinical trials involving randomization to standard care or standard care plus CM conditions, we assessed the impact of past year income, alone and in combination with treatment condition, as well as income type (i.e., earned, illegal, unstable) on the longest duration of continuous verified abstinence (LDA) achieved during treatment. Results suggested that income had no effect on LDA in either condition, and that CM's effectiveness did not deteriorate among those with better economic resources in the present sample. This finding may be of value to clinicians and administrators who are considering the addition of CM to standard care treatments in community outpatient substance abuse clinics and have concerns about the generalizability of CM across clients with various economic resources.

Full-text preview

Available from:
  • Source
    • "Thus, a $1 coupon book might be viewed as insignificant relative to his income. However, research indicates that income level is not related to the effectiveness of CM [34]. Rather, regardless of income, reinforcement magnitude likely needs to be of a sufficient level to spur behavior change. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Research indicates that contingency management (CM) has potential to improve a number of outcomes (e.g. substance use, treatment attendance, quality of life) among individuals with substance use and cooccurring disorders. However, multiple factors must be considered on a case-by-case basis in order to promote optimal treatment effects. The present study describes an individualized CM protocol for a US Veteran with substance dependence and cooccurring severe mental illness. CM targeted attendance at outpatient appointments and appropriate use of hospital resources. Effects of CM were assessed by comparing the 3-month baseline and CM periods. The CM intervention marginally reduced unnecessary hospital admissions, resulting in cost savings to the medical center of over $5,000 in three months for this individual. However, CM did not affect outpatient attendance. Several complications arose, highlighting challenges in using CM in populations with substance use and cooccurring disorders. Practical suggestions are offered for maximizing the effects of CM.
    01/2012; 2012:731638. DOI:10.1155/2012/731638
  • Source
    • "studies suggest no differential impact by client ethnicity (Barry et al., 2009), income (Rash et al., 2009), and psychiatric severity (Weinstock et al., 2007). Still, diverse needs and resources of treatment-seekers impact incentive choice and distribution. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Extant literature on contingency management (CM) transportability, or its transition from academia to community practice, is reviewed. The Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) guides the examination of this material. PsychInfo and Medline database searches identified 27 publications, with reviewed reference lists garnering 22 others. These 49 sources were examined according to CFIR domains of the intervention, outer setting, inner setting, clinicians, and implementation processes. Intervention characteristics were focal in 59% of the identified literature, with less frequent focus on clinicians (34%), inner setting (32%), implementation processes (18%), and outer setting (8%). As intervention characteristics, adaptability and trialability most facilitate transportability whereas non-clinical origin, perceived inefficacy or disadvantages, and costs are impediments. Clinicians with a managerial focus and greater clinic tenure and CM experience are candidates to curry organizational readiness for implementation, and combat staff disinterest or philosophical objection. A clinic's technology comfort, staff continuity, and leadership advocacy are inner setting characteristics that prompt effective implementation. Implementation processes in successful demonstration projects include careful fiscal/logistical planning, role-specific staff engagement, practical adaptation in execution, and evaluation via fidelity-monitoring and cost-effectiveness analyses. Outer setting characteristics-like economic policies and inter-agency networking or competition-are salient, often unrecognized influences. As most implementation constructs are still moving targets, CM transportability is in its infancy and warrants further scientific attention. More effective dissemination may necessitate that future research weight emphasis on external validity, and utilize models of implementation science.
    Drug and alcohol dependence 12/2011; 122(1-2):1-10. DOI:10.1016/j.drugalcdep.2011.11.011 · 3.42 Impact Factor
  • Source
    • "Therefore, these variables may not negatively affect CM treatment outcomes, and the implementation of CRA plus vouchers program for cocaine addiction may not be limited to a certain patient profi le. In this regard, recent studies have demonstrated that some individual differences, including those related to socioeconomic variables, recent gambling or psychopathological disorders such as antisocial personality disorder, do not affect CM effi cacy (Messina, Farabee, & Rawson, 2003; Petry & Alessi, 2010; Rash et al., 2009 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Características individuales y efi cacia del Manejo de Contingencias en el tratamiento de la adicción a la cocaína. Los programas de manejo de contingencias (MC) basados en incentivos han demostrado su efi cacia en el tratamiento de la adicción a la cocaína, pero pocos estudios han evaluado la relación entre el perfi l de adictos a la cocaína y la efi cacia de los procedimientos de MC. El objetivo de este estudio, en el que participaron 50 adictos a la cocaína en tratamiento en un programa de MC, consistió en evaluar el impacto de las características individuales de los pacientes sobre la abstinencia. El 58% de los participantes se encontraban abstinentes a los seis meses de tratamiento. Los pacientes con puntuaciones más altas en el área de Alcohol del EuropASI, y aquellos que consumieron cocaína durante el primer mes de tratamiento, tenían menos probabilidad de logar la abstinencia a los seis meses. Las implicaciones clínicas de estos resultados apuntan la necesidad de reforzar las intervenciones cuando los pacientes no respondan inicialmente a tratamiento, y detectar e intervenir sobre el consumo problemático de alcohol. El resto de variables examinadas no predecían de forma signifi cativa la abstinencia. Este hallazgo es importante para generalizar el uso de programas de MC entre distintos perfi les de adictos a la cocaína que demandan tratamiento.
    Psicothema 02/2011; 23(1):114-8. · 0.96 Impact Factor
Show more