Lowering costs in drug abuse treatment clinics.

An extensive body of literature demonstrates the efficacy of contingency management (CM) for improving outcomes in substance abuse treatment patients. The most widely studied CM procedure uses vouchers as the reinforcers, which are provided to patients whenever they demonstrate objective evidence of a target behavior, such as abstinence or treatment attendance. Vouchers have a monetary value and can be exchanged for retail items or services. Despite the demonstrated efficacy of voucher-based CM, a disadvantage of voucher CM programs from the perspective of sustainability in community-based treatment settings is the costs associated with administration and management. Not only must the costs of the vouchers be considered, but so must the staff time to track earnings and purchase and dispense items.

This chapter discusses some adaptations or novel applications of CM programs that can help make them sustainable when bringing this empirically based intervention to the context of community-based settings. It also describes the steps necessary in designing a prize-based CM system, including which behaviors to reinforce and how best to reinforce them. The second part of the chapter focuses on the scientific evidence supporting the efficacy of CM, featuring a description of the MIEDAR (“Motivational Incentives for Enhanced Drug Abuse Recovery”) studies in the National Drug Abuse Treatment Clinical Trials Network (CTN), protocols CTN-0006 and CTN-0007.

To request a copy of this item, contact ctnlib@uw.edu.

Related protocols: CTN-0006, CTN-0007