Effective contingency management (CM) programs for stimulant and/or opioid use disorder have median inflation-adjusted payment incentives of $128 per week for voucher protocols and $55 per week for prize protocols, according to a report in JAMA Psychiatry.
“These data are intended as starting points or a guide; complex protocols or programs that focus on challenging clinical presentations may need to consider more robust reinforcement schedules,” wrote lead author Carla J. Rash, Ph.D., of the University of Connecticut Health School of Medicine, and colleagues.
CM interventions—such as the California Recovery Incentives Program—make use of monetary incentives (typically gift cards/vouchers or entries for a cash prize drawing) to encourage patient participation in substance abuse treatment. While CM programs have more than 40 years of research support, they are not widely used in the United States.
Rash and colleagues reviewed 112 published CM protocols that involved reinforcement of stimulant- and/or opioid-negative urine drug tests and categorized each protocol as having small, medium, or large effect sizes compared with a non-CM program. They then computed weekly inflation-adjusted incentive payments for voucher- and prize-based protocols.
Of the 112 protocols coded, 49 protocols (44%) reinforced stimulant-negative urine drug tests only, seven protocols (6%) reinforced opioid-negative urine drug tests only, 24 (21%) reinforced both stimulant- and opioid-negative urine drug tests, and 32 protocols (29%) reinforced treatment for additional drugs beyond stimulants and/or opioids (alcohol, benzodiazepines, cannabis, barbiturates, phencyclidine).
Results showed that for the most common protocol length of 12 weeks, the optimal weekly payments in programs that showed moderate to large effect sizes would total about $1,536 ($128/week) for voucher and $660 ($55/week) for prize protocols.
To put these numbers in context, the authors noted that weekly estimated costs for first-line treatments approved by the Food and Drug Administration for opioid use disorder are $126 for methadone treatment, $115 for buprenorphine, and $271 for injectable naltrexone.
“At this time, CM is the treatment with the strongest evidence of efficacy for stimulant use disorders, yet CM remains underused in clinical applications,” they wrote. “In the midst of the continuing opioid and stimulant crisis, our field has the opportunity to invest in evidence-based CM as an effective treatment for substance use disorders.”
For more information, see the Psychiatric News article “Experts Discuss Options for Treating Stimulant Use Disorder.”
(Image: Getty Images/iStock/CarlosDavid.org)
Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.
