\u201cSetting people up for success and then failure\u201d \u2013 health care and service providers\u2019 experiences of using prize-based contingency management

Marilou Gagnon,Alayna Payne,Adrian Guta

doi:10.1186/s13011-020-00316-z

Marilou Gagnon, Alayna Payne + Show 1 more

Open Access

https://doi.org/10.1186/s13011-020-00316-z

Copy DOI

Abstract

BackgroundOver the last 50 years, there has been a growing interest in and use of contingency management (CM) for people who use substances. Yet, despite showing some level of efficacy (albeit only short-term) and being praised by researchers as beneficial and cost-saving, it continues to be underutilized by health care and service providers. Why that is remains unclear.MethodsRecognizing a gap, we conducted a targeted analysis of a larger set of qualitative interviews conducted on the experience of health care and service providers with incentives (including prize-based CM) (n = 25).ResultsFour themes were identified during the analysis: 1) The specificities of prize-based CM, 2) The role of providers in administering prize-based CM, 3) The positive and negative impact on the relationship, and 4) The ethical concerns arising from prize-based CM. Overall, our findings are consistent with existing literature and suggest that providers are wary of using prize-based CM because they tend to value effort over success, support over reward, honesty over deceit, and certainty over probability and variability.ConclusionOur analysis offers additional insights into the experiences of providers who use prize-based CM and possibly some indications as to why they may not wish to work with this type of incentive. The question raised here is not whether there is enough evidence on the effectiveness of prize-based CM, but rather if this type of incentive is appropriate and ethical when caring for people who use substances.

Highlights

Over the last 50 years, there has been a growing interest in and use of contingency management (CM) for people who use substances
Four themes were identified 1) The specificities of prize-based CM, 2) The role of providers in administering prizebased CM, 3) The positive and negative impact on the relationship, and 4) The ethical concerns arising from prize-based CM
Our participants had multiple experiences of using incentives in various roles and in various settings. Those who had hands-on experiences with prize-based CM all used the same standard intervention whereby clients were asked to draw from a standard fish bowl as described above. This particular type of incentive was used with clients who used substances and clients who struggled with treatment adherence to reward processes, behaviors, and outcomes

Summary

Introduction

Over the last 50 years, there has been a growing interest in and use of contingency management (CM) for people who use substances. CM is rooted in operant conditioning ( known as instrumental conditioning) and based on the general principle that behaviors, such as substance use, are controlled by their consequences [6]. To modify such behaviors, one has to modify the consequences using positive or negative reinforcements [3]. When used with people who use substances, CM is typically designed to provide positive reinforcements in exchange for desired processes (e.g., attending a clinic appointment), behaviors (e.g., maintaining abstinence), and outcomes (e.g., negative urine drug screening) [1, 3, 4, 7]. Voucher-based CM provides set amounts in the form of vouchers that can be exchanged for goods or services Incentives broadly This table summarizes the key questions asked during the interview.

Methods

Results

Discussion

Conclusion