Incentives in public addiction treatment payment systems: Intended and unintended effects

Abstract

s / Drug and Alcohol Dependence 146 (2015) e34–e117 e79 reductions inwithdrawal and urges frombaseline through the final treatment week. Conclusions: Depressed and non-depressed smokers differed onpatterns ofwithdrawal andurges to smoke,with those reporting depression showing increased withdrawal and urges when they initially reduced smoking. Financial support: NIH R21DA021839, R01DA034537, Helene Lycacki/Joe Young, Sr. Funds (Michigan). http://dx.doi.org/10.1016/j.drugalcdep.2014.09.582 Incentives in public addiction treatment payment systems: Intended and unintended effects Sharon Reif, Maureen Stewart, Constance M. Horgan, B. Mohr Institute for Behavioral Health, The Heller School, Brandeis University, Waltham, MA, United States Aims: Innovative ways are needed to improve the quality of treatment for drug use disorders. Performance-based contracting (PBC) aims to align program incentives and purchaser goals, yet is uncommon indrugabuse treatment systems. In2007,Maine implemented a second-generation PBC systemwith financial incentives, for outpatient programs, addressing problems identified with its previous PBC. This study aims to (1) determine whether rewarded measures and outcomes changed under the PBC, (2) examine whether there was client selection due to the PBC and (3) explore possible unintended effects of the PBC. Methods: We use state administrative data from 2005 to 2011 andmultilevelmodeling techniqueswithadifference-in-difference approach, and a non-PBC comparison group, to determinewhether the 2007 PBC resulted in improved access and retention in treatment and whether positive or negative unintended effects stemmed from it. Results: Preliminary analyses (N=25,105 admissions) indicated that the probability of receiving four or more outpatient treatment sessions did not change significantly between the 2005–2007 preperiod and the 2008–2011 post-period (OR .9, p= .16) and was not significantly different in the PBC agencies from the non-PBC agencies. Similarly there was no significant change in the probability of remaining in treatment for 90 days or more. The most significant predictors of retention were client characteristics (previous treatment, criminal justice involvement and homelessness). Client selection problems were not identified in an analysis of admission rates for individualswith diagnosedmental disorders.We continue to refine these models and examine the impact of the PBC on other factors and client outcomes. Conclusions: Introduction of a PBC is a significant change in payment design that may affect how drug treatment services are delivered, thus increasing our understanding of its effects is critical. Inpreliminary analyseswefind theoverall net effect of incentivized contract very small and not significant. Financial support: NIDA R01 DA033402. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.583 A comparison of drug-related deaths in Florida, 2007–2012 C.J. Reissig, J.M. Vojtech Health and Human Services, U.S. Food and Drug Administration, Silver Spring, MD, United States Aims: The state of Florida maintains extensive and publicly available death records data tracking a variety of prescription and recreational drugs of abuse. The aim of this study was to examine the most frequently occurring drug-related deaths in Florida from 2007 to 2012. Conclusions: Drug-related death data were obtained from the state of Florida for the years 2007–2012. The leading causes of drug-related deaths in Florida from 2007 to 2012 involved opioids and benzodiazepines. The Florida death data were sorted by the type of drug(s) involved in death: amphetamines, ethanol, benzodiazepines, inhalants, opioids or “other.” Preliminary analyses examined specific drugs that were present at death including hydrocodone, oxycodone, alprazolam, and carisoprodol. Data were sorted to observe the numbers of deaths per year, and the number of deaths classified as “causal” or “present.” Finally, we examined the number of deaths that occurred when each drug was used in combination with one or more other drugs. The majority of deaths occurred when oxycodone and hydrocodone were used in combination with at least one other substance. Alprazolam was the most common drug found in combination with hydrocodone or oxycodone. Financial support: N/A. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.584 Sex and drugs in the lives of minority women: A multi-level analysis of smartphone-based daily diary data Grace L. Reynolds1, Dennis G. Fisher1, Jean-Philippe Laurenceau2 1 California State University, Long Beach, Long Beach, CA, United States 2 University of Deleware, Newark, DE, United States Aims: African American and Latina women are at increased risk of HIV infection through heterosexual contact. Daily smartphonebased diaries can provide event-level information about the context of sex and drug use behaviors that may help in our understanding of why heterosexual contact is so risky for minority women. Theaimof this researchwas to investigatedruguse and sex risk through the use of electronic daily diary collection methods. Methods: 189 women were recruited into a smartphone daily diary study for a 12-week (84 days) diary period. Baseline interviews were completed and women consented to completing a data collection “app” using Samsung Android smartphones with unlimited text, Internet and voice capability provided by the study. Weekly incentiveswere provided for daily diary completion.Mplus was used for the multi-level analysis which specified a withinsubjectsprocesswherewepredicted thathigh-risk sexwouldoccur on days on which women also used illicit drugs.