Contingency Management: New Directions and Remaining Challenges for An Evidence-Based Intervention

Rash, Carla J.; Stitzer, Maxine L.; Weinstock, Jeremiah

doi:10.1016/j.jsat.2016.09.008

Cited by 95 publications

(43 citation statements)

References 149 publications

(183 reference statements)

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“…In post-study focus group and interviews, however, some agency staff expressed a sense that incentivizing clients would have been more effective. Some agencies used client incentive approaches and reported they were effective in increasing treatment attendance and completion, approaches which are backed up by evidence from the literature on contingency management (Rash, Stitzer, & Weinstock, 2016). …”

Section: Discussionmentioning

confidence: 99%

Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State

Garnick

Horgan

Acevedo

et al. 2017

Journal of Substance Abuse Treatment

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Financial incentives for quality improvement and feedback on specific clients are two approaches to improving the quality of treatment for individuals with substance use disorders. We examined the impacts of these interventions in Washington State by randomizing outpatient substance use treatment agencies into intervention and control groups. From October 2013 through December 2015, agencies could earn financial incentives for meeting performance goals incorporating both achievement relative to a benchmark and improvement from agencies’ own baselines. Weekly feedback was e-mailed to agencies in the alert or alert plus incentives arms. Difference-in difference regressions controlling for client and agency characteristics showed that none of the interventions significantly affected client engagement after outpatient admissions, overall or for sub-groups based on race/ethnicity, age, rural residence, or agency baseline performance. Treatment agencies offered insights related to several themes: delivery system context (e.g., agency time and resources needed during transition to a managed behavioral healthcare system), implementation (e.g., data lag), agency issues (e.g., staff turnover), and client factors (e.g., motivation). Interventions took place during a time of Medicaid expansion and planning for statewide integration of mental health and substance use disorder treatment into a managed care model, which may have resulted in agencies not responding to the interventions. Moreover, incentives and alerts at the agency-level may not be effective when factors are at play beyond the agency’s control.

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Section: Discussionmentioning

confidence: 99%

Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State

Garnick

Horgan

Acevedo

et al. 2017

Journal of Substance Abuse Treatment

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“…To modify such behaviors, one has to modify the consequences using positive or negative reinforcements [3]. When used with people who use substances, CM is typically designed to provide positive reinforcements in exchange for desired processes (e.g., attending a clinic appointment), behaviors (e.g., maintaining abstinence), and outcomes (e.g., negative urine drug screening) [1,3,4,7].…”

Section: Introductionmentioning

confidence: 99%

“…Two types of positive reinforcements are most commonly used, voucher-based CM and prize-based CM [7]. Voucher-based CM provides set amounts in the form of vouchers that can be exchanged for goods or services [7]. However, this type of CM intervention is too expensive [6].…”

Section: Introductionmentioning

confidence: 99%

“Setting people up for success and then failure” – health care and service providers’ experiences of using prize-based contingency management

Gagnon

Guţă

Payne

2020

Subst Abuse Treat Prev Policy

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Background Over the last 50 years, there has been a growing interest in and use of contingency management (CM) for people who use substances. Yet, despite showing some level of efficacy (albeit only short-term) and being praised by researchers as beneficial and cost-saving, it continues to be underutilized by health care and service providers. Why that is remains unclear. Methods Recognizing a gap, we conducted a targeted analysis of a larger set of qualitative interviews conducted on the experience of health care and service providers with incentives (including prize-based CM) (n = 25). Results Four themes were identified during the analysis: 1) The specificities of prize-based CM, 2) The role of providers in administering prize-based CM, 3) The positive and negative impact on the relationship, and 4) The ethical concerns arising from prize-based CM. Overall, our findings are consistent with existing literature and suggest that providers are wary of using prize-based CM because they tend to value effort over success, support over reward, honesty over deceit, and certainty over probability and variability. Conclusion Our analysis offers additional insights into the experiences of providers who use prize-based CM and possibly some indications as to why they may not wish to work with this type of incentive. The question raised here is not whether there is enough evidence on the effectiveness of prize-based CM, but rather if this type of incentive is appropriate and ethical when caring for people who use substances.

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“…Customizing the implementation of CM to suit with Malaysian environment, setting and culture is a part of the study that can be investigated especially in a multiracial country such as Malaysia. Innovative ideas in the adaptation of CM such as making it reasonably low cost can benefit not only the treatment service provider, but also for the patient and to the government as the financial provider (Rash, Stitzer, & Weinstock, 2016). The government has spent a lot of money for the treatment and rehabilitation of drug addicts and the cost increased each year.…”

Section: Resultsmentioning

confidence: 99%

A Randomized Controlled Trial of Contingency Management Therapy in Enhancing Treatment Engagement in a Drug Rehabilitation Centre

Ghani¹,

Amat²,

Rahimi³

et al. 2018

IJHSS

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Background and aims: Contingency management (CM) is a highly effective intervention and has been widely tested and evaluated in the context of substance abuse treatment worldwide. However, this approach is still new in developing countries such as Malaysia. This article aims at determining the effect of CM on treatment engagement within a psychosocial program in a compulsory treatment center in Malaysia. Methods: A randomized controlled trial design was used in this study. A total of 45 methamphetamine-dependent inmates were selected as subjects and randomly assigned into two groups namely the experimental group of treatment as usual + contingency management (TAU+CM) (n=22) and the controlled group of treatment as usual (TAU) (n=23). The TAU+CM group followed a 12-week CM intervention and 4-week follow up session without CM reinforcement. Meanwhile, the TAU group went through 16 weeks of usual psychosocial session implemented in the center. Measurements: The primary outcome of the study was treatment engagement within treatment sessions. It is measured by three parameters which are the assessment of (1) homework completion, (2) active participation and (3) understanding of treatment session. CM reinforcement in a form of star stickers with certain monetary value was given to subjects who achieved the targeted goal in the TAU+CM group. The value of the stickers started from RM2.00 and the magnitude would increase every four weeks. No reinforcement was given in the TAU group. Findings: The TAU+CM group seemed to enhance the treatment engagement within the 12-week psychosocial program. Overall, both groups have showed an increased treatment engagement with the TAU+CM group has a higher achievement than the TAU group. However, the overall differences between the groups were not statistically significant, thus rejecting the main hypothesis of the study which hypothesized that there will be significant differences in treatment engagement between the TAU+CM group and TAU group. Conclusion: The study of CM in a special population, especially in a compulsory treatment center, has been very challenging for researchers. Some studies had similar insignificant result could be due to the special population effect which needs to be further investigated in future studies.

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Contingency Management: New Directions and Remaining Challenges for An Evidence-Based Intervention

Cited by 95 publications

References 149 publications

Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State

Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State

“Setting people up for success and then failure” – health care and service providers’ experiences of using prize-based contingency management

A Randomized Controlled Trial of Contingency Management Therapy in Enhancing Treatment Engagement in a Drug Rehabilitation Centre

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