Voucher-Based Incentives in a Prevention Setting
Condition: Substance-related Disorders
MeSH terms: Substance-Related Disorders
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      This study evaluates a contingency management program that rewards homeless,
      non-treatment-seeking substance abusing men who have sex with men (MSM) for abstaining from
      drugs and for performing prosocial behaviors. If this program motivates these individuals to
      increase prosocial and healthy behaviors and decrease drug/alcohol use, established
      prevention programs may modify their approaches to include contingency management, and use it
      to address the staggering public health problems homeless substance-abusing MSMs face on a
      daily basis.
    

Detailed description: 
      Homelessness is a significant problem plaguing American cities and homeless substance abusers
      face increased risks. Homeless, substance abusing men who have sex with men (MSM) suffer 80%
      HIV seroprevalence, engage in the sex trades and resist treatment for substance abuse. For
      almost 30 years, the Van Ness Recovery House (VNRH) has been providing treatment services to
      homeless substance-abusing MSMs in Hollywood, CA. In 1994, VNRH began providing
      community-based HIV prevention services to non-treatment seeking homeless substance-abusing
      MSMs through the VNPD, its prevention division. Contingency management interventions
      providing positive incentives for behavior change may be particularly well suited for this
      disenfranchised, high-risk cohort. Specifically, voucher-based incentive therapies (VBRT) may
      be particularly effective since they have established potency for increasing prosocial
      behaviors that successfully compete with taking drugs and for reducing drug use. A
      randomized, controlled trial will assign 144 non-treatment seeking homeless substance-abusing
      MSMs at VNPD to either VBRT or control groups (72/group) for 24 weeks, with planned follow up
      at 7, 9 and 12 months from randomization. The VBRT group will earn vouchers in exchange for
      completing prosocial and healthy behaviors and/or submitting drug-negative urine and
      alcohol-negative breath samples. Vouchers will be redeemable for goods located in an onsite
      voucher store. The control group will receive feedback regarding behaviors performed and
      urinalysis and breath alcohol tests, but will not receive voucher points for these behaviors.
      We will assess the efficacy of the VBRT intervention for increasing prosocial and healthy
      behavior and reducing substance abuse among these non-treatment seeking homeless
      substance-abusing MSMs receiving services at VNPD. We will also assess the impact of VBRT on
      other measures of therapeutic change consistent with a harm reduction approach, including
      reduction of psychiatric symptoms, decreased injection drug use and high-risk sexual
      behavior, increased participation in prevention programming, improvement in different domains
      of overall functioning (medical/social/vocational), and increased readiness to change.
      Additionally, we will examine whether baseline participant characteristics predict VBRT
      outcomes. Applying VBRT to non-treatment seeking homeless substance-abusing MSMs as well as
      integrating VBRT into a well-established prevention program with a harm reduction philosophy
      are both highly innovative. Our reinforcement contingencies will also shape behavioral steps
      towards more complex behaviors, employing a basic operant tenet that has not received
      sufficient attention. Overall, our proposed research has the potential to have a significant
      impact on the public health of the Los Angeles homeless, gay and bisexual community. If VBRT
      is efficacious for motivating non-treatment seeking homeless substance-abusing MSMs in a
      community-based prevention program to increase prosocial and healthy behaviors and decrease
      drug/alcohol use, established prevention programs may modify their approaches to include
      contingency management, and use it to address the staggering public health problems HGMSAs
      face on a daily basis.
    

Intervention name(s): Voucher-Based Reinforcement Therapy
Intervention type(s): Behavioral
Intervention description(s): Participants were randomized into either the CM or control condition. Both conditions earned points for attendance and participation (max 364 points).
Participants in the CM condition also earned points for targeted health-promoting behaviors and for drug/alcohol abstinence. CM points for targeted health-promoting behaviors were not limited. Points for abstaining from substance use were awarded based on a Level 1 (recent abstinence for amphetamine, methamphetamine, PCP, and cocaine metabolites, as well as blood alcohol <0.05) urine sample.
Other intervention name(s): VIPS
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Drug Abuse; Contingency management; Voucher-based Reinforcement Therapy; Homosexuality; Homeless Persons