The Effect of a Contingency Management Intervention on Substance Use

Study Overview
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Brief Summary
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Contingency management interventions involve providing a tangible reward for progress toward treatment goals. The purpose of this study is to determine whether a contingency management intervention added to usual care leads to improved attendance and decreased substance use in patients attending outpatient substance use disorders treatment.

Detailed Description
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Design: This will be a randomized, controlled trial. 360 veterans presenting for specialty substance use disorders treatment at the Minneapolis VAMC and the VA Puget Sound Health Care System will be randomly assigned to 8 weeks of Usual Care or Usual Care plus Contingency Management. Minimal exclusion criteria include primary cannabis dependence, primary opioid dependence, screening positive for pathological gambling, serious psychiatric symptoms or suicide risk. Randomization will be stratified by site and primary substance use disorder (alcohol or stimulant). All participants will meet with a research assistant twice per week to submit urine drug and breath alcohol samples. Participants randomized to the contingency management interventions will have the opportunity to draw tokens (with replacement) from a bowl each time they submit negative urine drug and breath alcohol screens. The number of drawings allowed escalates with continuous weeks of negative screens or returns to baseline if screens are positive or missed. Half of the 500 tokens will result in social reinforcement (Good Job!). The remainder will earn a VA canteen voucher worth monetary value. Follow-up assessments occur 2, 6, and 12 months after enrollment into the study. Primary outcomes measures include number of days with negative urine drug and breath alcohol screens during the intervention phase, days of treatment attendance during the intervention phase, and percent days abstinent on the Timeline Follow-Back interview at follow-up assessments. Secondary outcomes include a brief assessment of employment, housing, legal, and psychiatric status, and administrative data on VA service utilization. A process evaluation and an economic analysis are included.

Official Title
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Effectiveness of Contingency Management in VA Addictions Treatment

Conditions
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Substance Use Disorders

Intervention / Treatment
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* Behavioral: Contingency Management
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: veterans presenting for outpatient substance use disorders treatment with a diagnosis of alcohol, cocaine, amphetamine, or methamphetamine dependence Exclusion Criteria: primary cannabis dependence primary opioid dependence severe psychiatric symptoms suicide risk positive history or screen for pathological gambling lacking transportation or living too far away to attend twice per week research appointments

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Contingency Management<br>Participants complete urine and breath screens 2 times per week for 8 weeks. If urine and breath screens are negative, they receive a chance to draw tokens from a bowl. Some tokens are social reinforcement. Others have monetary value. | Behavioral: Contingency Management<br>* Participants complete urine and breath screens 2 times per week for 8 weeks. If urine and breath screens are both negative, the participant receives a chance to draw tokens from a bowl. Some tokens are social reinforcement (Good Job!). Other have monetary value.<br>|
| Placebo Comparator: Placebo<br>Participants complete urine and breath screens 2 times per week for 8 weeks with no reinforcement for negative results. | Other: Placebo<br>* Participants complete urine and breath screens 2 times per week for 8 weeks with no reinforcement for negative results.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Negative Breath Alcohol and Urine Drug Screens Out of Possible 16 |  | 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Psychiatric Status | Kessler Psychological Distress Scale (K10) - score range 10 to 50. score under 20 are likely to be well score 20-24 are likely to have mild psychological distress score 25-29 are likely to have moderate psychological distress score 30 and over are likely to have a severe psychological distress | 8 weeks, 6 months, 12 months | 
| VHA Healthcare Service Utilization | Cost of total healthcare utilization for six month period between baseline and 6 month follow up and six month period between 6 month and 12 month follow up. | Baseline to 6 month follow up and 6 month follow up to 12 month follow up. | 
| Housing | Number of participants reporting stable housing (owned or rented house, apartment or room) | 8 week, 6 month and 12 month follow-ups | 
| Legal Status | Number of participants reporting detention or incarceration in the previous 30 days | 8 weeks, 6 month and 12 month follow ups | 
| Employment Status | Number of participants identifying themselves as unemployed. | 8 week, 6 month and 12 month follow up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Contingency management interventions, Substance use disorders treatment, Treatment effectiveness, Randomized clinical trial, Behavioral research