Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: A systematic review and meta-analysis

Ainscough, Tom; McNeill, Ann; Strang, John; Calder, Robert; Brose, Leonie S.

doi:10.1016/j.drugalcdep.2017.05.028

Cited by 61 publications

(34 citation statements)

References 63 publications

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“…Contingency management (CM) is an approach that involves offering rewards contingent on engagement in substance use treatment and on evidence of abstinence. CM has now accumulated a robust evidence base in a variety of contexts, including smoking cessation, 26,27 heavy drinking 28 and drug misuse [29][30][31][32][33][34][35] and, in a fairly recent trial of a 12-week CM intervention, it was found to be clinically effective and cost-effective in reducing stimulant misuse in a cohort of patients with severe mental illness. 36 Furthermore, the National Institute for Health and Care Excellence (NICE) has recommended that it be adopted in the UK.…”

Section: Resultsmentioning

confidence: 99%

A contingency management intervention to reduce cannabis use and time to relapse in early psychosis: the CIRCLE RCT

Rains

Marwaha

Strang

et al. 2019

Health Technol Assess

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Background Cannabis is the most prevalent illicit substance among people with psychosis, and its use is associated with poorer clinical and social outcomes. However, so far, there has been limited evidence that any treatment is effective for reducing use. Contingency management (CM) is an incentive-based intervention for substance misuse that has a substantial evidence base across a range of substances and cohorts. However, to date there have been no randomised controlled trials (RCTs) of CM as a treatment for cannabis use specifically in psychosis. Objective To conduct a RCT investigating the clinical effectiveness and cost-effectiveness of CM in reducing cannabis use among Early Intervention in Psychosis (EIP) service users. Design The CIRCLE (Contingency Intervention for Reduction of Cannabis in Early Psychosis) trial was a rater-blinded, multicentre RCT with two arms. Participants were randomised 1 : 1 to either an CM arm, in which participants received CM for cannabis use alongside an optimised treatment-as-usual programme including structured psychoeducation, or a control arm in which participants received the treatment as usual only. Setting EIP services across the Midlands and the south-east of England. Participants The main eligibility criteria were EIP service users with a history of psychosis, aged 18–36 years, and having used cannabis at least once per week during 12 of the previous 24 weeks. Intervention The CM intervention offered financial incentives (i.e. shopping vouchers) for cannabis abstinence over 12 once-weekly sessions, confirmed using urinalysis. The maximum value in vouchers that participants could receive was £240. Main outcome measures The main outcome was time to relapse, operationalised as admission to an acute mental health service or hospital. The primary outcome was assessed at 18 months post inclusion using electronic patient records. Secondary outcomes assessed the clinical effectiveness and cost-effectiveness of the intervention, for which data were collected at 3 and 18 months. Results A total of 278 participants were randomised to the CM arm and 273 were randomised to the control arm. In total, 530 (96%) participants were followed up for the primary outcome. There was no significant difference in time to admission between trial arms by 18 months following consent (hazard ratio 1.03, 95% confidence interval 0.76 to 1.40). There were no statistically significant differences in most secondary outcomes, including cannabis use, at either follow-up assessment. There were 58 serious adverse events, comprising 52 inpatient episodes, five deaths and one arrest. Limitations Participant retention was low at 18 months, limiting the assessment of secondary outcomes. A different CM intervention design or reward level may have been effective. Conclusions The CM intervention did not appear to be effective in reducing cannabis use and acute relapse among people with early psychosis and problematic cannabis use. Future work Cannabis use is still a significant clinical concern in this population. A pressing need remains to identify suitable treatments. A wider perspective on the social circumstances of young people with psychosis may be needed for a successful intervention to be found. Trial registration Current Controlled Trials ISRCTN33576045. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 45. See the NIHR Journals Library website for further project information.

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Section: Resultsmentioning

confidence: 99%

A contingency management intervention to reduce cannabis use and time to relapse in early psychosis: the CIRCLE RCT

Rains

Marwaha

Strang

et al. 2019

Health Technol Assess

Self Cite

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“…Behavioural interventions have proved effective for the treatment of other forms of addiction [75–77]. There is growing evidence that reducing punishment—such as incarceration—and adopting positive reinforcement for people with substance use improves their access to services, their reintegration into society, and, ultimately, public safety [78–80].…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis

et al. 2018

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BackgroundClinical guidelines recommend psychosocial interventions for cocaine and/or amphetamine addiction as first-line treatment, but it is still unclear which intervention, if any, should be offered first. We aimed to estimate the comparative effectiveness of all available psychosocial interventions (alone or in combination) for the short- and long-term treatment of people with cocaine and/or amphetamine addiction.Methods and findingsWe searched published and unpublished randomised controlled trials (RCTs) comparing any structured psychosocial intervention against an active control or treatment as usual (TAU) for the treatment of cocaine and/or amphetamine addiction in adults. Primary outcome measures were efficacy (proportion of patients in abstinence, assessed by urinalysis) and acceptability (proportion of patients who dropped out due to any cause) at the end of treatment, but we also measured the acute (12 weeks) and long-term (longest duration of study follow-up) effects of the interventions and the longest duration of abstinence. Odds ratios (ORs) and standardised mean differences were estimated using pairwise and network meta-analysis with random effects. The risk of bias of the included studies was assessed with the Cochrane tool, and the strength of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We followed the PRISMA for Network Meta-Analyses (PRISMA-NMA) guidelines, and the protocol was registered in PROSPERO (CRD 42017042900). We included 50 RCTs evaluating 12 psychosocial interventions or TAU in 6,942 participants. The strength of evidence ranged from high to very low. Compared to TAU, contingency management (CM) plus community reinforcement approach was the only intervention that increased the number of abstinent patients at the end of treatment (OR 2.84, 95% CI 1.24–6.51, P = 0.013), and also at 12 weeks (OR 7.60, 95% CI 2.03–28.37, P = 0.002) and at longest follow-up (OR 3.08, 95% CI 1.33–7.17, P = 0.008). At the end of treatment, CM plus community reinforcement approach had the highest number of statistically significant results in head-to-head comparisons, being more efficacious than cognitive behavioural therapy (CBT) (OR 2.44, 95% CI 1.02–5.88, P = 0.045), non-contingent rewards (OR 3.31, 95% CI 1.32–8.28, P = 0.010), and 12-step programme plus non-contingent rewards (OR 4.07, 95% CI 1.13–14.69, P = 0.031). CM plus community reinforcement approach was also associated with fewer dropouts than TAU, both at 12 weeks and the end of treatment (OR 3.92, P < 0.001, and 3.63, P < 0.001, respectively). At the longest follow-up, community reinforcement approach was more effective than non-contingent rewards, supportive-expressive psychodynamic therapy, TAU, and 12-step programme (OR ranging between 2.71, P = 0.026, and 4.58, P = 0.001), but the combination of community reinforcement approach with CM was superior also to CBT alone, CM alone, CM plus CBT, and 12-step programme plus non-contingent rewards (ORs between 2.50, P = 0.039, and 5.22, P < ...

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“…A switch from methadone to buprenorphine 121 is an alternative or complementary strategy. The finding that methadone exposure duration is unrelated to craving suggests a lingering relapse risk during methadone maintenance and emphasizes the significance of its integration with non-pharmacological interventions including contingency management 122 or mindfulness-based techniques 123 . A potentially beneficial effect of buprenorphine on opioid craving begs further validation.…”

Section: Discussionmentioning

confidence: 99%

Metabolic and Addiction Indices in Patients on Opioid Agonist Medication-Assisted Treatment: A Comparison of Buprenorphine and Methadone

Elman

Howard²,

Borodovsky

et al. 2020

Sci Rep

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Metabolic hormones stabilize brain reward and motivational circuits, whereas excessive opioid consumption counteracts this effect and may impair metabolic function. Here we addressed the role of metabolic processes in the course of the agonist medication-assisted treatment for opioid use disorder (OUD) with buprenorphine or methadone. Plasma lipids, hemoglobin A1C, body composition, the oral glucose tolerance test (oGtt) and the Sweet taste test (Stt) were measured in buprenorphine-(n = 26) or methadone (n = 32)-treated subjects with OUD. On the whole, the subjects in both groups were overweight or obese and insulin resistant; they displayed similar oGtt and Stt performance. As compared to methadone-treated subjects, those on buprenorphine had significantly lower rates of metabolic syndrome (MetS) along with better values of the high-density lipoproteins (HDL). Subjects with-vs. without MetS tended to have greater addiction severity. correlative analyses revealed that more buprenorphine exposure duration was associated with better HDL and opioid craving values. in contrast, more methadone exposure duration was associated with worse triglycerides-, HDL-, blood pressure-, fasting glucose-and hemoglobin A1C values. Buprenorphine appears to produce beneficial HDL-and craving effects and, contrary to methadone, its role in the metabolic derangements is not obvious. our data call for further research aimed at understanding the distinctive features of buprenorphine metabolic effects vis-à-vis those of methadone and their potential role in these drugs' unique therapeutic profiles. Opioid use disorder (OUD) is an ominous public health problem afflicting about 16 million people worldwide 1. In the US, OUD constitutes the seventh cause for disability-adjusted life-years 2-4 ; including opioids' propensity 5 for the excessive body weight gain (BWG) and its medical sequelae in the form of the 'Metabolic Syndrome' (MetS) 5-7 , that is to say, a cluster of interrelated cardiometabolic risk factors comprised of insulin resistance, impaired glucose tolerance, dyslipidemia, abdominal adiposity and hypertension 8-10. Consequently, even though medication-assisted treatment (MAT) via opioid agonist replacement with long-acting opioids namely, buprenorphine and methadone, usually yields positive clinical outcomes in terms of overdose mortality, infectious diseases, crime, and societal ties 11-14 concerns have been raised about further worsening of the metabolic status 5. There are several lines of evidence that link OUD to metabolic derangements. With regard to genetic antecedents, the TCF7L2 gene codes a transcription factor implicated 15,16 in non-insulin-dependent

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Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: A systematic review and meta-analysis

Cited by 61 publications

References 63 publications

A contingency management intervention to reduce cannabis use and time to relapse in early psychosis: the CIRCLE RCT

A contingency management intervention to reduce cannabis use and time to relapse in early psychosis: the CIRCLE RCT

Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis

Metabolic and Addiction Indices in Patients on Opioid Agonist Medication-Assisted Treatment: A Comparison of Buprenorphine and Methadone

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