Randomized Controlled Trial of Contingency Management for Stimulant Use in Community Mental Health Patients With Serious Mental Illness

Abstract

Objective The primary objective of this study was to determine if contingency management was associated with increased stimulant drug abstinence in community mental health outpatients with serious mental illness and stimulant dependence. Secondary objectives were to determine if contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV-risk behavior, and inpatient service utilization. Method A randomized controlled design compared outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomized to three months of contingency management for stimulant abstinence plus treatment-as-usual or treatment-as-usual with reinforcement for study participation only. Urine drug tests, self-report, clinician-report, and service utilization outcomes were assessed during three-month treatment and three-month follow-up periods. Results While participants in the contingency management condition were less likely to complete the treatment period (n=38; 42%) than those assigned to the control condition (n=55; 65%), X2(1)=9.8, p=0.02; those assigned to the contingency management condition were 2.4 (CI=1.9-3.0) times more likely to submit a stimulant-negative urine test during treatment. Participants assigned to contingency management experienced significantly lower levels of alcohol use, injection drug use, psychiatric symptoms, and were five times less likely than those assigned to the control condition to be admitted for psychiatric hospitalization, X2(1)=5.4, p=0.02. Contingency management participants reported significantly fewer days of stimulant drug use, relative to controls during the three-month follow-up. Conclusions When added to treatment-as-usual, contingency management is associated with large reductions in stimulant, injection drug, and alcohol use. Reductions in psychiatric symptoms and hospitalizations were important secondary benefits.

Do reward-processing deficits in schizophrenia-spectrum disorders promote cannabis use? An investigation of physiological response to natural rewards and drug cues

“…Our results, combined with recent findings on contingency management in psychiatric populations, 41 implicate the reward system as a promising approach for managing substance use in individuals with dual disorders. Future studies will need to consolidate this interpretation, as the associations we observed with cannabis use were not specific to rewarding stimuli and may indicate a more general deficit in emotional processing predicting cannabis use.…”

Toplum Ruh Sağlığı Merkezlerinde Hemşirenin Rolü

“…Bu personel tarafından, merkez bölgesinde bulunan kişilere danışmanlık, koruyucu bakım, terapi ve tedavi verilmesi ile hastaların sağlık durumlarında iyileşmelere destek sağlamaktadır. 11,[25][26][27][28][29][30][31][32][33] Ayrıca TRSM'ler hizmet alanlarında, özellikle erişim, kalite, tedavi planlamasına katılım ve iyileşme faktörlerini geliştirmek için diğer kurumlarla işbirliği yapabilirler. TRSM' ler gerekirse her bireye özel müdahale teknikleri geliştirerek birey ve toplum ruh sağlığı üzerinde koruyucu ve destekleyici etki oluşturarak toplumda genel memnuniyet düzeyini artırabilirler.…”

Revisión de la eficacia de los tratamientos para el trastorno bipolar en comorbilidad con el abuso de sustancias

“…No obstante, tanto el grupo de asesoramiento sobre drogas como la terapia integrada de grupo muestran una aparente eficacia en el abordaje del trastorno dual 47 . El manejo de contingencias también resultó adecuado para atenuar el consumo de alcohol y estimulantes, además de para incrementar la mejoría en síntomas maníacos y depresivos 44 . Asimismo, la intervención familiar para patología dual resultó más beneficiosa en educación sobre los trastornos, sintomatología psiquiátrica y severidad de consumo que la educación familiar 45 .…”