University of Southampton School of Medicine, Southampton SO14 3DT, UK.
Drug Alcohol Depend. 2011 Dec 1;119(1-2):56-63. doi: 10.1016/j.drugalcdep.2011.05.016. Epub 2011 Jun 15.
Contingency management (CM), despite the evidence base for its effectiveness, remains controversial, with sub-optimal implementation. In 2007, UK guidelines recommended the use of CM in publicly funded services, but uptake has also been minimal. Previous surveys of service providers suggest differences in opinions about CM, but to date there has been no published involvement of service users in this debate.
Focus group methodology was used to explore systematically the attitudes, concerns and opinions of staff and service users about the use of CM, in publicly funded substance misuse services, to identify the key areas that may be influential in terms of implementation and outcome. Data were analysed thematically using the constant comparative method.
70 staff and service users participated in 9 focus groups. 15 themes of discussion around CM were identified, grouped into four categories: how CM was aligned to the philosophy of substance misuse services; the practicalities of implementation; wider ethical concerns; and how participants perceived the evidence for effectiveness.
Robust process evaluation in different treatment systems is needed to define the active components of CM for implementation. Involvement of service users in this process is essential and is likely to provide valuable insights into the mechanism of action of CM and its effectiveness and uptake within complex treatment systems.
尽管有充分的证据表明应急管理（CM）有效，但它仍然存在争议，实施情况并不理想。2007 年，英国指南建议在公共资助的服务中使用 CM，但采用率也很低。之前对服务提供者的调查表明，他们对 CM 的看法存在差异，但迄今为止，还没有服务使用者参与这一辩论。
采用焦点小组方法系统地探讨了工作人员和服务使用者对在公共资助的药物滥用服务中使用 CM 的态度、关注和意见，以确定在实施和结果方面可能有影响的关键领域。使用恒定性比较方法对数据进行了主题分析。
70 名工作人员和服务使用者参加了 9 个焦点小组。确定了围绕 CM 的 15 个讨论主题，分为四类：CM 如何与药物滥用服务的理念保持一致；实施的实际情况；更广泛的伦理问题；以及参与者如何看待有效性的证据。
需要在不同的治疗系统中进行强有力的过程评估，以确定 CM 的有效实施的具体内容。服务使用者的参与对于这一过程至关重要，并且很可能为 CM 的作用机制及其在复杂治疗系统中的有效性和采用提供有价值的见解。
