Kropp Frankie, Lewis Daniel, Winhusen Theresa
Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA.
Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA.
J Subst Abuse Treat. 2017 Jan;72:111-116. doi: 10.1016/j.jsat.2016.06.012. Epub 2016 Jun 29.
Research has consistently found contingency management (CM) to be an effective tool in increasing desired patient behaviors in substance use disorder (SUD) treatment. Despite the strong evidence for the effectiveness of this intervention, practical issues and the cost of implementing CM in treatment programs have been significant barriers to adoption.
To evaluate the impact of a CM program designed and implemented by university-affiliated methadone clinic staff to increase patient group attendance. The CM program consisted of a weekly raffle for patients attending clinician-led group counseling and/or in-clinic Methadone Anonymous (MA) groups in which slips with patient ID#s were entered and one ID slip was drawn per week with a fee credit for a dose of methadone ($15) as the prize.
The CM program continued for 12 months. Group attendance was tracked before, during, and after CM implementation as part of ongoing clinic service utilization monitoring.
Following the implementation of CM, attendance at any clinician-led or MA groups increased significantly from baseline to month 1 (X=5.78, p<0.05) but this increase was not sustained beyond month 6. Analysis of attendance by type of group revealed that clinician-led group attendance did not increase significantly but there was a significant increase in in-clinic MA group attendance from baseline to month 1 (X=20.27, p<0.001), which was sustained through the 12-month implementation period (X=11.21, p<0.001) and through 3 months post-implementation (X=14.73; p<0.001).
A low-cost, simple CM intervention implemented by clinic staff was associated with significant increases in the target behavior of increasing group attendance.
研究一直发现，应急管理（CM）是增加物质使用障碍（SUD）治疗中患者期望行为的有效工具。尽管有强有力的证据证明这种干预措施有效，但在治疗项目中实施CM的实际问题和成本一直是采用该措施的重大障碍。
评估由大学附属美沙酮诊所工作人员设计和实施的CM项目对提高患者团体出勤率的影响。该CM项目包括每周为参加临床医生主导的团体咨询和/或诊所内匿名戒酒会（MA）团体的患者举办抽奖活动，活动中会放入带有患者身份证号码的纸条，每周抽取一张身份证纸条，奖品是一剂美沙酮的费用抵免（15美元）。
CM项目持续了12个月。作为诊所持续服务利用监测的一部分，在CM实施前、实施期间和实施后对团体出勤率进行跟踪。
CM实施后，参加任何临床医生主导或MA团体的出勤率从基线到第1个月显著增加（X = 5.78，p < 0.05），但这种增加在第6个月后没有持续。按团体类型分析出勤率发现，临床医生主导的团体出勤率没有显著增加，但诊所内MA团体的出勤率从基线到第1个月显著增加（X = 20.27，p < 0.001），在12个月的实施期内持续增加（X = 11.21，p < 0.001），并在实施后3个月内持续增加（X = 14.73；p < 0.001）。
诊所工作人员实施的低成本、简单的CM干预与团体出勤率这一目标行为的显著增加相关。
