Economic cost of the therapeutic workplace intervention added to methadone maintenance

Knealing, Todd W.; Roebuck, M. Christopher; Wong, Conrad J.; Silverman, Kenneth

doi:10.1016/j.jsat.2007.04.013

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…Participants earned $8.00 per hour in base pay and could earn up to $2.00 more per hour based on their productivity in the computerized training programs. Detailed descriptions of the therapeutic workplace, the web-based training programs, the staffing requirements, and the cost of the intervention can be found elsewhere (DeFulio, Donlin, Wong, & Silverman, 2009; Donlin, Knealing, Needham, Wong, & Silverman, 2008; Knealing, Roebuck, Wong, & Silverman, 2008; Silverman et al, 2007). …”

Section: Methodsmentioning

confidence: 99%

Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes.

Dunn¹,

DeFulio²,

Everly³

et al. 2015

Psychology of Addictive Behaviors

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Oral naltrexone could be a promising relapse prevention pharmacotherapy for recently detoxified opioid-dependent patients, however interventions are often needed to promote adherence with this treatment approach. We recently conducted a study to evaluate a 26-week employment-based reinforcement intervention of oral naltrexone in unemployed injection drug users (Dunn et al., 2013). Participants were randomly assigned into a Contingency (n=35) group required to ingest naltrexone under staff observation to gain entry into a therapeutic workplace, or a Prescription (n=32) group given a take-home supply of oral naltrexone and access to the workplace without observed ingestion. Monthly urine samples were collected and analyzed for evidence for naltrexone adherence, opioid use, and cocaine use. As previously reported, Contingency participants provided significantly more naltrexone-positive urine samples than Prescription participants during the 26-week intervention period. The goal of this current study is to report the 12-month outcomes, which occurred 6 months after the intervention ended. Results at the 12-month visit showed no between-group differences in naltrexone-positive, opioid-negative, or cocaine-negative urine samples, and no participant self-reported using naltrexone at the follow-up visit. These results show that even after a period of successfully reinforced oral naltrexone adherence longer-term naltrexone use is unlikely to be maintained after reinforcement contingencies are discontinued.

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Section: Methodsmentioning

confidence: 99%

Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes.

Dunn¹,

DeFulio²,

Everly³

et al. 2015

Psychology of Addictive Behaviors

Self Cite

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show abstract

“…Overall, voucher earnings were arranged such that participants could earn a base pay of $8.00/hour for the hours worked in the workplace plus approximately $2.00/hour for their performance on the training programs, for a total potential wage of $10/hour. Detailed descriptions of the therapeutic workplace, the web-based training programs, the staffing requirements, and the cost of the intervention can be found elsewhere (DeFulio, Donlin, Wong, & Silverman, 2009; Donlin, Knealing, Needham, Wong, & Silverman, 2008; Knealing, Roebuck, Wong, & Silverman, 2008; Silverman et al, 2007). Participants in the Prescription group were eligible to work and earn vouchers independent of naltrexone consumption and/or drug use, however Contingency participants were only permitted to work when naltrexone consumption was objectively confirmed (described in more detail below).…”

Section: Methodsmentioning

confidence: 99%

Employment-based reinforcement of adherence to oral naltrexone treatment in unemployed injection drug users.

Dunn¹,

DeFulio²,

Everly³

et al. 2013

Experimental and Clinical Psychopharmacology

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Naltrexone has high potential for use as a relapse prevention pharmacotherapy for opiate dependence; however suffers from notoriously poor adherence when prescribed for oral self-administration. This study evaluated whether entry to a therapeutic workplace could be used to reinforce adherence with oral naltrexone. Opiate-dependent and cocaine-using injection drug users were detoxified, inducted onto oral naltrexone, and randomly assigned to a Contingency (n=35) or Prescription (n=32) group for a 26-week period. Contingency participants were required to ingest naltrexone under staff observation to gain access to the therapeutic workplace. Prescription participants received a take-home supply of naltrexone and could access the workplace independent of naltrexone ingestion. Primary outcome measures were percent of urine samples positive for naltrexone at 30-day assessments and negative for opiates and cocaine at 30-day assessments. Contingency participants provided significantly more urine samples that were positive for naltrexone compared to Prescription participants (72% vs. 21%, P<.01), however no effect of experimental group was observed on percent opiate-negative (71% vs. 60%, P=.19.) or cocaine-negative (56% vs. 53%, P=.82) samples in the Contingency and Prescription groups, respectively. Opiate-positive samples were significantly more likely to occur in conjunction with cocaine (P<.001), and when not protected by naltrexone (P<.02), independent of experimental group. Overall, these results show that contingent access to a therapeutic workplace significantly promoted adherence to oral naltrexone, and that the majority of opiate use occurred in conjunction with cocaine use, suggesting that untreated cocaine use may limit the effectiveness of oral naltrexone in promoting opiate abstinence.

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“…Indeed, incentive-based policies for a range of health behaviors are being increasingly adopted by health maintenance organizations and policymakers in the U.S. and internationally (Higgins, 2010; Pear, 2009; Rosenberg, 2008). Finally, other creative approaches for mitigating incentive costs include fee rebates, deposit contracting and delivering incentives on an intermittent or random schedule (Amass & Kamien, 2008; Cahill & Perera, 2008, 2011; Elliot & Tighe, 1968; Kaper et al, 2005; Knealing et al, 2008; Paxton, 1980, 1981, 1983; Petry & Alessi, 2008; Winett, 1973). For example, deposit contracting typically requires that the patient make an initial monetary deposit which can then be recouped based on smoking abstinence.…”

Section: Challengesmentioning

confidence: 99%

The use of financial incentives in promoting smoking cessation

Sigmon

Patrick

2012

Preventive Medicine

124

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Objective Cigarette smoking is the leading cause of preventable death in the U.S. and world. Despite the availability of numerous therapies for smoking cessation, additional efficacious interventions are greatly needed. We provide a narrative review of published studies evaluating financial incentives for smoking cessation and discuss the parameters important for ensuring the efficacy of incentive interventions for smoking cessation. Methods Published studies that evaluated the impact of incentives to promote smoking cessation and included an appropriate control or comparison condition were identified and reviewed. Results Incentives are efficacious for promoting smoking abstinence across the general population of smokers as well as substance abusers, adolescents, patients with pulmonary disease, patients with serious mental illness and other challenging subgroups. To develop and implement an effective incentive treatment for smoking, special attention should be paid to biochemical verification of smoking status, incentive magnitude and the schedule of incentive delivery. Conclusion Consistent with the extensive literature showing that incentives are effective in reducing illicit drug use, a large body of evidence supports their effectiveness in reducing smoking. Continued efforts are warranted to further develop and disseminate incentive-based treatments for smoking cessation across clinical settings and populations.

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Economic cost of the therapeutic workplace intervention added to methadone maintenance

Cited by 12 publications

References 21 publications

Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes.

Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes.

Employment-based reinforcement of adherence to oral naltrexone treatment in unemployed injection drug users.

The use of financial incentives in promoting smoking cessation

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