Cunningham Colin, Stitzer Maxine, Campbell Aimee N C, Pavlicova Martina, Hu Mei-Chen, Nunes Edward V
Johns Hopkins University School of Medicine, Department of Psychiatry.
Johns Hopkins University School of Medicine, Department of Psychiatry.
J Subst Abuse Treat. 2017 Jan;72:134-139. doi: 10.1016/j.jsat.2015.08.010. Epub 2015 Sep 21.
To examine prize-earning costs of contingency management (CM) incentives in relation to participants' pre-study enrollment drug use status (baseline (BL) positive vs. BL negative) and relate these to previously reported patterns of intervention effectiveness.
Participants were 255 substance users entering outpatient treatment who received the therapeutic educational system (TES), in addition to usual care counseling. TES included a CM component such that participants could earn up to $600 in prizes on average over 12-weeks for providing drug negative urines and completing web-based cognitive behavior therapy modules. We examined distribution of prize draws and value of prizes earned for subgroups that were abstinent (BL negative; N=136) or not (BL positive; N=119) at study entry based on urine toxicology and breath alcohol screen.
Distribution of draws earned (median=119 vs. 17; p<.0001) and prizes redeemed (median=54 vs. 9; p<.001) for drug abstinence differed significantly for BL negative compared to BL positive participants. BL negative earned on average twice as much in prizes as BL positive participants ($245 vs. $125). Median value of prizes earned was 5.4 times greater for BL negative compared to BL positive participants ($237 vs. $44; p<.001).
Two-thirds of expenditures in an abstinence incentive program were paid to BL negative participants. These individuals had high rates of drug abstinence during treatment and did not show improved abstinence outcomes with TES versus usual care (Campbell et al., 2014). Effectiveness of the abstinence-focused CM intervention included in TES may be enhanced by tailoring delivery based on patients' drug use status at treatment entry.
研究应急管理（CM）激励措施的奖金成本与参与者研究前入组时的药物使用状况（基线（BL）阳性与BL阴性）之间的关系，并将这些关系与先前报道的干预效果模式联系起来。
255名进入门诊治疗的药物使用者参与了研究，他们除了接受常规护理咨询外，还接受了治疗性教育系统（TES）。TES包括一个CM组件，参与者通过提供毒品阴性尿液和完成基于网络的认知行为治疗模块，可以在12周内平均获得高达600美元的奖金。我们根据尿液毒理学和呼气酒精筛查，研究了在研究入组时 abstinent（BL阴性；N = 136）或未 abstinent（BL阳性；N = 119）亚组的抽奖分布和获得的奖金价值。
与BL阳性参与者相比，BL阴性参与者在药物 abstinence方面获得的抽奖次数（中位数 = 119对17；p <.0001）和兑换奖金（中位数 = 54对9；p <.001）分布存在显著差异。BL阴性参与者获得的奖金平均是BL阳性参与者的两倍（245美元对125美元）。与BL阳性参与者相比，BL阴性参与者获得的奖金中位数价值高5.4倍（237美元对44美元；p <.001）。
禁欲激励计划中三分之二的支出支付给了BL阴性参与者。这些个体在治疗期间药物 abstinence率较高，与常规护理相比，TES并未显示出 abstinence结果的改善（Campbell等人，2014年）。根据患者治疗入组时的药物使用状况调整TES中以 abstinence为重点的CM干预措施的实施方式，可能会提高其有效性。
