Decision-making tendencies and voucher spending independently support abstinence within contingency management for methamphetamine use disorder.

Abstract

Decision-making tendencies and spending within cash voucher-based interventions have individually beenshown to be related to future abstinence among participants with methamphetamine use disorder (MUD), but less is known of their independent contributions. This study of participants in a contingency management (CM) trial investigated whether decision-making and spending were each associated with future abstinence. Thirty-two outpatients with MUD, predominately male (68%) and mixed ancestry (94%) with a median age of 34 years, participated in an 8-week cash voucher-based CM pilot trial. Prior to commencing the trial, participants completed a computerized Iowa Gambling Task (IGT) to measure decision-making preferences for more frequent rewards and longer term gains of greater magnitude. Spending and abstinence of participants were tracked over the duration of the trial. In a secondary analysis, time-lagged counting process Cox Proportional Hazard models were conducted. Baseline decision-making, characterized by a preference for frequent rewards, was associated with a greater likelihood of future spending, Hazard Ratio; HR = 1.13 [1.06: 1.21]. Avoidance of short-term rewards to realize longer term, higher magnitude rewards, and spending at the prior visit were each associated with abstinence on the trial,

Decision-making task performance and patterns of methamphetamine use in people assigned male at birth who have sex with men.

“…Our analyses provide further evidence that the IGT, especially the subscore for Blocks 4 and 5, may be a useful tool for assessing risk of MA use and severity of use. While previous research on the IGT and MA has primarily focused on the IGT's utility for predicting outcomes in treatment settings (Lake et al, 2020(Lake et al, , 2023Nejtek et al, 2013), our analyses establish a connection between IGT performance and the extent of MA use in people not actively seeking treatment. Therefore, we cannot infer clinical relevance from these findings alone.…”

“…The virtual currency is not used in the scoring and only serves to simulate loss and reward. The net total score is calculated as the number of selections taken from the two low-risk decks minus the number of selections taken from the two high-risk decks, which is the convention used in the founding study (Bechara et al, 1994), construct validity analysis (Buelow & Suhr, 2009), and various studies on the IGT and MA use (Duarte et al, 2012; Lake et al, 2020, 2023; Nejtek et al, 2013; van der Plas et al, 2009). Therefore, high IGT scores represent good IGT performance (low risk taking).…”

“…Cross-sectional studies suggest associations between poor IGT performance (greater risk-taking) and stimulant use (Duarte et al, 2012; van der Plas et al, 2009). Findings from small clinical trials suggest that poor IGT performance at baseline predicts lower improvement in MA use in response to contingency management (Lake et al, 2020, 2023), a positive-reinforcement intervention with efficacy for reducing MA use (Brown & DeFulio, 2020). In patients receiving outpatient care for concurrent MA use disorder and bipolar disorder, poor IGT performance at baseline predicted future MA use (Nejtek et al, 2013).…”