Contingency Management for Patients With Dual Disorders in Intensive Outpatient Treatment for Addiction

Abstract

Objective This project investigated the effectiveness of contingency management for improving retention in treatment and positive outcomes among patients with dual disorders in intensive outpatient treatment for addiction. Methods The effect of contingency management was explored among a group of 160 patients exposed to contingency management (n = 88) and not exposed to contingency management (no contingency management, n = 72) in a partial hospitalization program. Patients referred to the partial hospitalization program for treatment of substance use and comorbid psychiatric disorders were diagnosed by psychiatrists and specialist clinicians according to the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV-TR). A unique application of the contingency management “fishbowl” method was used in the to improve consistency of attendance at treatment sessions, which patients attended five days a week. Days attending treatment and drug-free days were the main outcome variables. Other outcomes of interest were depression, anxiety and psychological stress, coping ability, and intensity of drug cravings. Results Patients in the contingency management group attended more treatment days compared to patients in the no contingency management group; M = 16.2 days (SD = 10.0) vs. M = 9.9 days (SD = 8.5), respectively; t = 4.2, df = 158, p<.001. No difference was found between the treatment groups on number of drug-free days. Psychological stress and drug craving were inversely associated with drug-free days in bivariate testing (r =−.18, p<.02; r = −.31, p<.001 respectively). Treatment days attended and drug craving were associated with drug-free days in multivariate testing (B = .05, SE =.01, β = .39, t =4.9, p <.001; B = −.47 SE = .12, β = −.30, t =−3.9, p <.001; respectively; Adj. R2 = .21). Days attending treatment partially mediated the relationship between exposure to contingency management and self-reported drug-free days. Conclusions Contingency management is a valuable adjunct for increasing retention in treatment among patients with dual disorders in partial hospitalization treatment. Exposure to contingency management increases retention in treatment, which in turn contributes to increased drug-free days. Interventions for coping with psychological stress and drug cravings should be emphasized in intensive dual diagnosis group therapy.

A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies

“…Participants enrolled in the CM condition were approximately twice as likely to remain in treatment longer than those in the control condition. 55 However, this study found no significant differences between participants in the CM and control conditions in levels of depression, anxiety, stress, drug cravings, coping ability, or number of drug-abstinent days. In a larger study reported by McDonell et al in 2013, outpatients with SMI receiving CM for stimulant drug abstinence, participants randomized to the CM condition were 2.4 times more likely than controls to submit a stimulant-negative urine sample during treatment.…”

A review of the literature on contingency management in the treatment of substance use disorders, 2009–2014

“…Regarding illicit drug use disorders, studies were reported on CM reducing marijuana use (Kaminer et al, 2014; Stanger et al, 2009) among adolescents, and psychomotor stimulant and poly-drug use among those with co-morbid mental illness (García-Fernández et al, 2013; Kelly et al, 2014; McDonell et al, 2013; Petry et al, 2013), socioeconomic disadvantage (Secades-Villa et al, 2013), pregnant women and mothers of young children (Schottenfeld et al, 2011), sexual minorities (specifically men who have sex with men, Menza et al, 2010; Reback et al, 2010), those with HIV infection (Petry et al, 2010), and military veterans (Hagedorn et al, 2013). …”

Preventing Criminal Recidivism Through Mental Health and Criminal Justice Collaboration

“…Also, new models, such as effective practices in community supervision (the "EPICS" model), have been developed to teach probation and parole officers evidence-based principles of effective behavioral management (53). Unlike cognitive-behavioral therapies for criminal thinking, however, behavioral management principles are often used by mental health professionals within residential and day programs for persons with co-occurring mental illness and substance use disorders (54,55). These observations provide a clear rationale for mental health-criminal justice collaboration in planning and treatment, including deciding who is responsible for providing which treatments and services for each client.…”