Contingency management (CM) interventions are among the most effective methods for initiating and maintaining drug abstinence during drug abuse treatment. Unfortunately, community treatment providers perceive these procedures as being inconsistent with their usual practices, too costly, and too complex. Surveys of treatment providers have identified eight aspects of CM interventions that they find objectionable or inconsistent with usual care: 1) CM has most often been delivered in individual vs. group formats; 2) It has focused on tangible vs. social incentives; 3) It rewards only one vs. multiple behaviors; 4) It often has been studied in groups of patients that are homogenous with respect to their preferred drugs of abuse when patients who are abusing different drugs tend to be treated in heterogeneous groups; 5) The incentive costs are excessive: 6) It requires too much staff time; 7) It requires more frequent urinalysis than clinics can afford; and 8) It raises concerns about negative side-effects such as arguing between patients. The goal of this Stage 1 research is to determine which of these concerns can be reasonably addressed without seriously compromising the efficacy of the intervention. This project will develop a Group CM intervention and conduct 3 small-N reversal design pilot studies that will examine: a) one vs. multiple target behaviors; b) reduced urine testing frequency; and c) including patients using cocaine or benzodiazepines in the same group. It also will collect cost data to estimate the relative expense associated with the CM interventions, convene an advisory panel of local treatment providers, and use panel feedback in combination with the results of studies to guide decision-making regarding the inclusion or exclusion of specific Group CM procedures. Finally, preliminary data will be collected to establish ESs for a subsequent application that will compare the Group CM treatment with Individual CM and standard treatment. By the end of this project, all the products of Stage I research necessary to develop a Group CM intervention that is more consistent with the needs of community treatment providers will have been completed. Interesting pilot data regarding important specific aspects of CM interventions will also be available (i.e., number of behaviors targeted, frequency of urine testing). While developing this Group CM intervention will not by itself result in improved dissemination of CM, it is a critical first step in this direction.
| Kirby, Kimberly C; Kerwin, Marylouise E; Carpenedo, Carolyn M et al. (2008) Interdependent group contingency management for cocaine-dependent methadone maintenance patients. J Appl Behav Anal 41:579-95 |
