Voucher-based Contingency Management Research Articles

Contingency Management for the Treatment of Methamphetamine Use Disorders

Theory and some preliminary evidence suggest that contingency management may be an effective treatment strategy or adjunct to psychosocial treatment for methamphetamine use disorders. An experimentally rigorous investigation on the topic was provided by a large multisite trial conducted under the auspices of the Clinical Trials Network of the National Institute on Drug Abuse. The authors report data on 113 participants who were diagnosed with methamphetamine abuse or dependence. They were randomly assigned to receive 12 weeks of either treatment as usual or treatment as usual plus contingency management. Urine samples were tested for illicit drugs, and breath samples were tested for alcohol. The reinforcers for drug-negative samples were plastic chips, some of which could be exchanged for prizes. The number of plastic chips drawn increased with each week of negative samples but was reset to one after a missed or positive sample. The participants in both groups remained in treatment for equivalent times, but those receiving contingency management in addition to usual treatment submitted significantly more negative samples, and they were abstinent for a longer period of time (5 versus 3 weeks). These results suggest that contingency management has promise as a component in treatment strategies for methamphetamine use disorder.

Voucher-based contingent reinforcement of marijuana abstinence among individuals with serious mental illness

Previous studies by our group have used money given contingent on abstinence to reduce drug use by individuals with schizophrenia. In this study, we examined the sensitivity of marijuana use by individuals with serious mental illness to voucher-based contingent reinforcement, which represents the first study to date investigating the efficacy of voucher incentives with this population. This within-subject reversal design consisted of three conditions: 4-week baseline, 12-week voucher intervention, and 4-week baseline. During baseline periods, subjects received US$10 vouchers per urine specimen, independent of urinalysis results. During voucher intervention, only specimens testing negative for marijuana earned vouchers, with total possible earnings of US$930. Seven adults with schizophrenia or other serious mental illnesses participated in the study. The percentage of marijuana-negative specimens was significantly greater during voucher intervention than during baseline periods. These results provide evidence that marijuana use among individuals with serious mental illness is sensitive to voucher-based incentives and further support the potential feasibility of using voucher-based contingency management to reduce substance abuse in this challenging population.

A Comparison of Voucher Exchanges Between Criminal Justice Involved and Noninvolved Participants Enrolled in Voucher-Based Contingency Management Drug Abuse Treatment Programs

This report compares requests for goods or services made by participants in two clinical trials of contingency management for the treatment of substance abuse. One trial was for participants involved with the criminal justice system and one was for participants who were not involved with the criminal justice system. In both trials, participants earned vouchers that could be exchanged for goods or services. Results indicated that the criminal justice group used the majority of their vouchers for paying fees or fines related to the criminal justice system while the other group used only a small portion of their vouchers for paying costs related to the criminal justice system. However, when the costs for the criminal justice system are removed, the proportion of vouchers exchanged for various goods and services are similar between the two groups. The results suggest that for those substance abusers involved in the criminal justice system, assistance in paying fines and fees related to their criminal justice system involvement may be a potentially powerful source of reinforcement that could be used in creative treatment strategies.

Voucher Purchases in Contingency Management Interventions for Women with Cocaine Dependence

Objective Voucher-based Contingency Management (CM) has been shown to be effective in treating cocaine dependence, but the relative impact of extensive voucher purchase guidelines has not been evaluated. Consequently, our objective was to investigate the effect of purchase guidelines on voucher purchases. Methods We evaluated voucher purchases made by 94 cocaine dependent women who were enrolled in a randomized clinical trial of the Community Reinforcement Approach (CRA) versus Twelve-Step Facilitation (TSF), where extensive purchase guidelines were only part of CRA. Results In CRA, 70% of the purchases were consistent with the guidelines offered. The most frequent purchases were for social/recreational activities (30%), the participant's child (non-basic needs; 17%), and household items (15%). There were no significant differences in percentages of purchases between CRA and TSF. Additionally, preliminary findings on the relationship between voucher purchase patterns and cocaine abstinence are presented. Conclusion The findings suggest that extensive purchase guidelines may not be a critical aspect of voucher reward programs.

Clinical implications of reinforcement as a determinant of substance use disorders.

Extensive scientific evidence indicates that reinforcement plays an important role in the genesis, maintenance, and recovery from substance use disorders. In this chapter, we review recent clinical research from laboratory, clinic, and naturalistic settings examining the role of reinforcement in substance use disorders. Well-controlled human laboratory studies are reviewed characterizing orderly interactions between the reinforcing effects of drugs and environmental context that have important implications for understanding risk factors for substance use disorders and for the development of efficacious interventions. Recent treatment-outcome studies on voucher-based contingency management and community reinforcement therapy are reviewed demonstrating how reinforcement and related principles can be used to improve outcomes across a wide range of different substance use disorders and populations. Overall, the chapter characterizes a vigorous area of clinical research that has much to contribute to a scientific analysis of substance use disorders.