Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, USA.
Drug Alcohol Depend. 2010 Feb 1;107(1):76-9. doi: 10.1016/j.drugalcdep.2009.09.006. Epub 2009 Oct 13.
Vaccines represent a new and promising avenue of treatment for drug abuse but pose new medication adherence challenges due to prolonged and widely spaced administration schedules. This study examined effects of prize-based incentives on retention and medication adherence among 26 cocaine users involved in a 6-month hepatitis B vaccination series. Participants could meet with research staff weekly for 24 weeks and receive 7 injections containing either the Hepatitis B vaccine or a placebo. All participants received $10 at each weekly visit (maximum of $240). Those randomly assigned to the incentive program received additional monetary payments on an escalating schedule for attendance at weekly monitoring and vaccination visits with maximum possible earnings of $751. Group attendance diverged after study week 8 with attendance better sustained in the incentive than control group (group by time interaction, p=.035). Overall percent of weekly sessions attended was 82% for incentive versus 64% for control (p=.139). Receiving all scheduled injections were 77% of incentive versus 46% of control participants (p=.107). A significantly larger percentage (74% versus 51%; p=.016) of injections were received by incentive versus control participants on the originally scheduled day. Results suggest that monetary incentives can successfully motivate drug users to attend sessions regularly and to receive injected medications in a more reliable and timely manner than may be seen under usual care procedures. Thus, incentives may be useful for addressing adherence and allowing participants to reap the full benefits of newly developed medications.
疫苗代表了治疗药物滥用的一种新的、有前途的途径，但由于给药时间延长且间隔时间长，因此带来了新的药物依从性挑战。本研究考察了基于奖励的激励措施对 26 名参与乙肝疫苗接种系列的可卡因使用者的保留和药物依从性的影响。参与者可以在 24 周内每周与研究人员会面，并接受 7 次注射，其中包含乙肝疫苗或安慰剂。所有参与者在每次每周就诊时可获得 10 美元（最高 240 美元）。那些随机分配到奖励计划的人会根据参加每周监测和疫苗接种就诊的次数获得额外的金钱奖励，最高可能获得 751 美元。研究第 8 周后，小组出勤率出现分歧，奖励组的出勤率高于对照组（组间时间交互作用，p=.035）。奖励组每周参加的会议百分比为 82%，而对照组为 64%（p=.139）。接受所有计划注射的奖励组参与者为 77%，而对照组参与者为 46%（p=.107）。在原定日期，接受奖励的参与者中有比例明显更大（74%对 51%；p=.016）的注射。结果表明，金钱奖励可以成功地激励吸毒者定期参加会议，并以比常规护理程序更可靠和及时的方式接受注射药物。因此，激励措施可能有助于解决依从性问题，并使参与者充分受益于新开发的药物。
