Contingency management abstinence incentives: Cost and implications for treatment tailoring.

This study aimed 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 education system (TES) in addiction to usual care counseling (as part of NIDA Clinical Trials Network protocol CTN-0044). 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. This secondary analysis 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.

Results found that 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).

Conclusions: 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 improve abstinence outcomes with TES versus usual care. Effectiveness of the abstinence-focused CM intervention in TES may be enhanced by tailoring delivery based on patients’ drug use status at treatment entry.

Related protocols: CTN-0044