Substance Abuse Treatment Patients in Housing Programs Respond to Contingency Management Interventions

Abstract

Use of homeless and transitional housing (e.g., recovery homes) programs can be associated with success in substance abuse treatment, perhaps because many of these programs encourage or mandate sobriety. In this study, we examined whether contingency management (CM) protocols that use tangible incentives for submission of drug-free specimens or other specific behaviors are effective for treatment-seeking substance abusers whose behavior may also be shaped by housing programs. Of 355 participants in randomized trials of CM, 56 (16%) reported using transitional housing during the 12-week treatment period. Main and interaction effects of housing status and treatment condition were evaluated for the primary substance abuse treatment outcomes: a) longest duration of abstinence from alcohol, cocaine, and opioids, b) percentage of samples submitted that were negative for these substances, and c) treatment retention. After controlling for demographic and clinical characteristics, those who accessed housing programs submitted a higher percentage of negative samples (75%) compared to those who did not access housing programs (67%). Housing status groups did not differ in terms of longest duration of abstinence (accessed housing: M = 3.1 weeks, SE = 0.6; did not access housing: M = 3.9 weeks, SE = 0.3) or retention in substance abuse treatment (accessed housing: M = 6.4 weeks, SE = 0.6; did not access housing: M = 6.6 weeks, SE = 0.3). Regardless of housing status, CM was associated with longer durations of abstinence and treatment retention. No interactive effects of housing and treatment condition were observed (p > .05). Results suggest that those who accessed housing programs during substance abuse treatment benefit from CM to a comparable degree as their peers who did not use such programs. These effects suggest that CM remains appropriate for those accessing housing in community-based programs.

A meta-analysis of cocaine use disorder treatment effectiveness

“…However, the positive association between contingency management treatment approaches and a significant reduction in objective cocaine use is not entirely surprising. Prior meta-analyses of contingency management for reducing cocaine use have suggested efficacy in particular clinical populations 21,27,28 , and a recent high-quality meta-analysis of psychosocial treatments with comparison groups for treatment of cocaine use disorders found contingency management the most effective treatment 29 . Moreover, large-scale implementation of contingency management for treatment of substance use disorders in the Department of Veterans Affairs (VA) has demonstrated both clinical effectiveness, similar to what has been reported in controlled trials, and low cost 38 .…”

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

“…Indeed, abstinent-contingent housing, in tightly controlled research settings, is a powerful contingency (Milby, Schumacher, Wallace, Freedman, & Vuchinich, 2005; Tuten et al, 2012). However, the results of Rash et al (2017) suggest that patients benefited from clinic-delivered CM regardless of community housing status, possibly because community-based housing contingencies are less carefully controlled and thus exert less influence on behavior than abstinent-contingent housing in research settings. As such, individuals in community housing programs appear to be appropriate candidates for CM programs based on this preliminary work.…”

“…They found that individuals who accessed recovery housing, regardless of whether it was provided as part of the intervention or obtained on their own, had better abstinence and employment outcomes than those who did not access recovery housing. In Rash et al (2017), those accessing housing had better outcomes on just one of the three primary outcomes, whereas effects of accessing recovery housing were more robust in Tuten et al (2017). This difference may in part be due to the mix of housing types (e.g., homeless shelters) included in Rash et al (2017), which may vary considerably in patient clinical characteristics and recovery support.…”

“…In Rash et al (2017), those accessing housing had better outcomes on just one of the three primary outcomes, whereas effects of accessing recovery housing were more robust in Tuten et al (2017). This difference may in part be due to the mix of housing types (e.g., homeless shelters) included in Rash et al (2017), which may vary considerably in patient clinical characteristics and recovery support. Further work in this area is needed, particularly with regard to how housing type, duration and abstinence policies might impact CM response.…”

“…Rash and colleagues (2017) further extend investigations of efficacy within special subgroups by examining whether SUD patients who are residing in community-based homeless and recovery housing programs during treatment respond to CM. Most of these programs encourage or mandate abstinence, and access to or loss of housing may be a powerful contingency that overshadows CM interventions as delivered in the clinic setting.…”