Pilot randomized controlled trial of an integrative intervention with methamphetamine-using men who have sex with men.

Adam W Carrico,Michael V Discepola,Michael D Siever,Judith T Moskowitz,Samantha E Dilworth,Walter Gómez

doi:10.1007/s10508-015-0505-5

Abstract

Contingency management (CM) is an evidence-based intervention that provides tangible rewards as positive reinforcement for biologically confirmed abstinence from substance use. Integrative approaches targeting positive affect regulation could boost the effectiveness of CM by sensitizing individuals to non-drug-related sources of reward and assisting them with effectively managing symptoms of withdrawal. This pilot randomized controlled trial with 21 methamphetamine-using men who have sex with men (MSM) examined the feasibility and acceptability of a 5-session, positive affect intervention delivered during CM-Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS). After completing 4 weeks of a 12-week CM program, participants were randomized to receive ARTEMIS+CM (n=12) or CM-only (n=9). Those randomized to receive the ARTEMIS positive affect intervention completed 98% of sessions and reported marginally significant increases in positive affect over the five sessions. In exit interviews with ARTEMIS+CM participants, individuals noted that the positive affect regulation skills increased self-awareness and led to greater engagement in the recovery process. ARTEMIS+CM participants reported significant increases in positive affect and CM-only participants reported significant reductions in negative affect over a 2-month follow-up. These affective changes were not maintained, and no concurrent effects on stimulant use or sexual risk taking were observed over the 6-month follow-up. More definitive clinical research is necessary to examine the efficacy of ARTEMIS+CM with methamphetamine-using MSM.

Highlights

Among men who have sex with men(MSM), there is emerging evidence of a syndemic multiple, overlapping psychosocial health problems that fuel the HIV/AIDS epidemic (Mustanski, Garofalo, Herrick, & Donenberg, 2007; Parsons, Grov, & Golub, 2012; Stall et al, 2003)
Effect size estimates from pilot studies should be interpreted with caution, participants randomized to receive ARTEMIS+Contingency management (CM) reported short-term increases in positive affect that were not sustained over the 6-month follow-up
Participants completed a detailed screening process for the CM program and the present pilot randomized controlled trial (RCT), it is plausible that some over-reported methamphetamine use to receive the incentives provided

Summary

Introduction

Among men who have sex with men(MSM), there is emerging evidence of a syndemic multiple, overlapping psychosocial health problems that fuel the HIV/AIDS epidemic (Mustanski, Garofalo, Herrick, & Donenberg, 2007; Parsons, Grov, & Golub, 2012; Stall et al, 2003). Control participants who received HIV prevention programming activities displayed substantial increases in the proportion of urine samples that were reactive for these stimulants These findings lend support to a prior RCT with methamphetamine-dependent MSM where those receiving CM alone or CM in combination with cognitive-behavioral therapy (CBT) were retained longer in treatment and had more consecutive urine samples that were negative for methamphetamine compared to men in CBT alone (Shoptaw et al, 2005). Due to poor participant attendance of CM visits, the CM protocol was modified to collect urine samples twice weekly instead of thrice weekly Because this provides a window for methamphetamine use to go undetected, contingent reinforcement of stimulant abstinence was subverted. Preliminary outcomes of this integrative intervention approach were examined over a 6-month follow-up period

Participants and Procedure

Results

Discussion