Effects of Contingent Payment on Compliance with a Naltrexone Regimen

Abstract

The effects of several schedules of payment on duration and patterns of compliance with a naltrexone regimen were examined. Patients were paid under contingencies based on either number of doses ingested or on a fixed time schedule. Reinforcement schedules based on number of doses ingested produced more consistent treatment-oriented behavior than a time-based schedule. Covariation between behavior and alternating contingencies (A-B-A) indicated that the schedules contributed to increased duration of treatment compared to previous noncontingent payment. The issue of using extrinsic reinforcers such as monetary payment to enhance compliance is discussed and additional procedures are suggested.

Should we pay the patient? Review of financial incentives to enhance patient compliance

“…Fifteen studies were excluded as they were not randomised,14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 eight studies were excluded because the trials compared the effect of different types of financial incentives without a control group as comparator,29 30 31 32 33 34 35 36 and two studies provided insufficient data for contingency tables to be developed 37 38…”

Naltrexone for heroin dependence treatment in St. Petersburg, Russia

“…However, despite its potential advantages, its impact on the practical treatment of opioid dependence in the U.S. has been low due to poor compliance (Rounsaville, 1995). Many efforts have been made to increase compliance including rewards for drug-free urines (Grabowski, 1979;Meyer, Mirin, & Zackow, 1979); combining it with psychosocial treatments such as behavior therapy (Callahan et al, 1980), individual counseling (Resnick, Schuyten-Resnick, & Washton, 1979) or family therapy (Anton & Hogan, 1981); or using it in the context of legal pressure (Cornish et al, 1997;Tennant, Rawson, Cohen, & Mann, 1984;Washton, Pottash, & Gold, 1984). Each of these interventions has been shown to increase compliance and efficacy, but they have not been widely applied.…”

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

“…As a result, several different intervention styles have been developed to promote continued adherence on naltrexone. These include family monitoring (Anton, Hogan, Jalali, Riordan, & Kleber, 1981; Summers & Stone, 2002), intensive behavioral counseling (Nunes, Rothenberg, Sullivan, Carpenter, & Kleber, 2006; Rawson et al, 2001; Roozen, Kerkhof, & van den Brink, 2003), and provision of monetary-based incentives to encourage continued adherence (Carroll et al, 2001; Grabowski et al, 1979; Preston et al, 1999). …”