Fitzsimons Heather, Tuten Michelle, Borsuk Courtney, Lookatch Samantha, Hanks Lisa
Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA.
University of Maryland School of Social Work, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA.
Drug Alcohol Depend. 2015 Jul 1;152:62-7. doi: 10.1016/j.drugalcdep.2015.04.021. Epub 2015 May 4.
This study examined the impact of a low-cost contingency management (CM) delivered by program clinicians on treatment attendance and utilization for patients enrolled in outpatient psychosocial substance abuse treatment.
The study used a pre-posttest design to compare substance abuse patients who received Reinforcement-Based Treatment (RBT) plus low cost CM (n=130; RBT+CM) to patients who received RBT only (n=132, RBT). RBT+CM participants received a $10 incentive for returning to treatment the day following intake assessment (day one), and a $15 incentive for attending treatment on day five following admission. RBT clients received standard care intervention without the addition of the CM procedures. Groups were compared on proportion of participants who returned to treatment on day one, mean days of treatment attendance, individual sessions attended, and treatment utilization during the first week and the first month following treatment admission.
Both the RBT+CM and RBT group participants returned to the clinic on day one at high rates (95% versus 89%, respectively). However, the RBT group participants were more likely to attend the intake assessment only (i.e., never return to treatment) compared to the RBT+CM participants. Additionally, the RBT+CM participants attended significantly more treatment days, attended more individual counseling sessions, and had higher rates of overall treatment utilization compared to the RBT participants during the one week and one month following treatment admission.
Findings support the feasibility and effectiveness of a CM intervention delivered by clinicians for increasing treatment attendance and utilization in a community substance abuse program.
本研究探讨了由项目临床医生提供的低成本应急管理（CM）对参加门诊社会心理药物滥用治疗患者的治疗出勤率和治疗利用率的影响。
该研究采用前后测设计，将接受基于强化的治疗（RBT）加低成本CM的药物滥用患者（n = 130；RBT + CM）与仅接受RBT的患者（n = 132，RBT）进行比较。RBT + CM参与者在摄入评估后的第二天（第一天）返回治疗可获得10美元奖励，入院后第五天参加治疗可获得15美元奖励。RBT客户接受标准护理干预，不增加CM程序。比较两组在第一天返回治疗的参与者比例、平均治疗出勤天数、参加的个别疗程以及治疗入院后第一周和第一个月的治疗利用率。
RBT + CM组和RBT组的参与者在第一天都以很高的比例返回诊所（分别为95%和89%）。然而，与RBT + CM参与者相比，RBT组参与者更有可能仅参加摄入评估（即不再返回治疗）。此外，在治疗入院后的一周和一个月内，与RBT参与者相比，RBT + CM参与者的治疗天数显著更多，参加的个别咨询疗程更多，总体治疗利用率更高。
研究结果支持临床医生实施的CM干预在提高社区药物滥用项目的治疗出勤率和利用率方面的可行性和有效性。
