Principal Investigator: John M. Roll, Ph.D. Friends Research Institute, Inc.
Abstract:
Contingency management interventions are quite successful at initiating and maintaining clinically significant periods of abstinence. Typically, contingency management is delivered in conjunction with a psychosocial substance abuse treatment program. However, there has been scant attention directed towards how to maximally deliver the contingency management interventions as part of a larger treatment package. One issue that will be important is to determine what the optimal length of a contingency management intervention should be.
This proposal describes an experimentally rigorous clinical trial designed to begin exploring this issue. Methamphetamine-dependent participants will be randomly assigned to one of four conditions: standard treatment (16 weeks of psychosocial treatment plus no contingency management), 1 month contingency management (16 weeks of psychosocial treatment with contingency management delivered during the first 4 weeks), 2 month contingency management (16 weeks of psychosocial treatment with contingency management delivered during the first 8 weeks), 4 month contingency management (16 weeks of psychosocial treatment with contingency management delivered during the entire 16 weeks).
Data will be analyzed to determine if the different durations of contingency management produce different rates of initiation of abstinence or different patterns of maintenance of abstinence. Follow up data collection will be conducted for a one year period, starting at randomization, to determine if the different durations of contingency management inculcate longer periods of posttreatment abstinence or result in different patterns of relapse. This proposal is responsive to NIDA’s Behavioral Therapies Development (Phase 1) research agenda.
The successful completion of the proposed project will serve several purposes. First, it will provide data that will be useful in determining what the optimal length of contingency management interventions should be. This will be useful as we begin to transfer the contingency management approaches into community-based treatment clinics. This may also help to contain the cost of delivering contingency management interventions if it is demonstrated that shorter durations of contingency management are as effective as longer durations. Secondly, the successful completion of the proposed research will provide additional information on the utility of treating methamphetamine dependence with contingency management. This is timely, given the burgeoning rates of methamphetamine abuse being reported.
Contingency management refers to the systematic application of basic principles delineated by workers in the field of the Experimental Analysis of Behavior to treat the problem behavior of individuals. Primary emphasis is placed on the use of reinforcement to alter an individual’s day-to-day behavior. Over the past decade, contingency management procedures have been refined for the treatment of a variety of substance abuse disorders and related problems (e.g., Higgins, Alessi & Dantona, 2002; Higgins & Silverman, 1999, Stitzer & Higgins, 1995). These procedures have been very successful in reducing drug use (e.g., Higgins & Silverman, 1999; Petry, 2000). Recently, efforts have been undertaken to examine the different components involved in the delivery of contingency management interventions in order to understand what components of the interventions are needed to maximize treatment success and to attempt to make the interventions more suitable for use in community-based clinics. The study proposed in this application seeks to further our understanding of contingency management by investigating how different lengths of exposure to contingency management interventions, delivered in combination with psychosocial drug abuse treatment, influence the initiation and maintenance of abstinence among methamphetamine-dependent individuals. It is appropriate to explore these issues in methamphetamine-dependent participants because methamphetamine abuse is reaching epidemic levels in certain geographic locales and effective treatments for this problem are limited. The successful completion of the study outlined in this application should yield information that will help refine contingency management procedures and, perhaps, assist in transferring these procedures to community-based settings. The proposed study will also provide data on the use of contingency management for the treatment of methamphetamine dependence.
To determine if different durations (0 {standard care}, 1-, 2-, and 4-months) of an established contingency management intervention, when delivered in combination with a psychosocial substance abuse treatment program, produce different rates of initiation of abstinence, different patterns of abstinence during and following the interventions, and different patterns of relapse in the year following treatment among methamphetamine-dependent individuals. Methamphetamine use will be measured using urine toxicology and self-report of methamphetamine use.
To determine if the different durations of the contingency management intervention influence the length of time participants remain in treatment. Retention will be measured by the number of treatment sessions attended.
To determine if the different durations of the contingency management intervention influence the degree to which individuals report craving for methamphetamine. Craving outcomes will be measured using a visual analogue scale.
To determine if the different durations of the contingency management intervention influence the frequency and intensity of somatic complaints and emotional functioning. These outcomes will be measured using the BSI, ASI, HIV Risk Assessment Battery, reports of adverse events and the Beck Depression Inventory.
To further establish the efficacy of contingency management in treating methamphetamine abuse and to further assess the usefulness of a variable magnitude of reinforcement procedure in this population.