Component IV - Contingency Management Treatment DurationContingency management (CM) interventions are highly efficacious in improving substance abusetreatment outcomes, but few studies have implemented this approach with alcohol use disorder patients.Further, no known studies have experimentally evaluated how duration of CM affects outcomes. This issueappears to be of central importance for impacting long-term behavior change, given the well-establishedassociation between length of treatment engagement and outcomes. In this application, we propose to evaluithe efficacy of prize-based CM when administered according to a usual duration of 12 weeks versus anextended duration of 24 weeks. We will also investigate how probabilities of reinforcement may impact therelationships between CM duration and outcomes.Alcohol abusing or dependent patients (N=310) beginning intensive outpatient day treatment at threecommunity based clinics will be randomly assigned to one of four conditions: (a) standard treatment as usual(ST) at the clinic without CM; (b) ST with CM for 12 weeks with a 0.5 probability of winning prizes for eachnegative sample submitted and an expected average maximum earnings of $300 in prizes; (c) ST with CM foi24 weeks with a 0.34 probability of winning prizes for each negative sample submitted and an expectedaverage maximum earnings of $300 in prizes; or (d) ST with CM for 24 weeks with a 0.5 probability of winnincprizes for each negative sample submitted and an expected average maximum earnings of $500 in prizes.During weeks 1-12, two breath samples per week will be collected from all patients, and those in the CMconditions will have the opportunity to win prizes for submission of negative samples. Those assigned to thelonger duration CM conditions will continue to receive reinforcement for negative samples provided weeklyduring weeks 13-24. In group d, probabilities of reinforcement will be identical to those used in group b, but thwill remain available for an additional 12 weeks. In group c, the probabilities of winning prizes will be lower sothat the magnitude of overall reinforcement is consistent with group b. Alcohol use, other drug use,psychosocial problems, and HIV risk behaviors will be measured at baseline, during and post treatment, andthroughout an 18-month follow-up period. We expect that CM will decrease alcohol use to a greater extent th non-CM treatment, and that availability of CM for 24 weeks may result in longer term benefits than 12 weekexposure to CM. This study will be the first to evaluate the effects of probability of winning prizes on responseCM. We will also assess patient characteristics that may be associated with improved outcomes within andacross treatments.
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