Contingency Management for Cocaine Dependence: Cash vs Vouchers

可卡因依赖的应急管理：现金与优惠券

• 批准号: 8076719
• 负责人: DAVID S FESTINGER
• 金额: $ 55.58万
• 依托单位: TREATMENT RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8076719
• 关键词: Abstinence; Address; Aftercare; Alcohol consumption; Benchmarking; Client; Clinic; Cocaine; Cocaine Dependence; Communities; Consent; Counseling; Dose; Drug Addiction; Drug usage; Empirical Research; Ethical Issues; Ethics; Evaluation; Gambling; Gifts; Goals; Health Personnel; Home environment; Incentives; Intervention; Investigation; Light; Methadone; Motivation; Outcome Measure; Outpatients; Pharmaceutical Preparations; Population; Prize; Procedures; Prostitution; Protocols documentation; Provider; Randomized; Research; Research Support; Resources; Rewards; Risk; Safety; Services; Societies; Substance Addiction; Substance abuse problem; Time; Treatment outcome; base; community based treatment; comparative efficacy; contingency management; cost; cost effectiveness; craving; design; drug abstinence; high risk behavior; improved; programs; psychosocial; reinforcer; standard care; stem; substance abuser; treatment program; voucher

DESCRIPTION (provided by applicant): Contingency management (CM) is a demonstrably efficacious intervention for substance abuse and dependence. Substantial empirical research supports its efficacy in increasing treatment attendance and drug abstinence. Although CM protocols have employed a variety of reinforcers, they have almost exclusively relied upon non-cash privileges (e.g., take-home methadone doses), prizes, or vouchers that can be exchanged for goods or services. Despite the strong empirical support for CM, our research suggests that concerns relating to its cost and safety (e.g., potential for harm caused by rewards undermining intrinsic motivation or being sold to purchase drugs) have hindered its transfer to real-world practice. The exclusive use of non-cash CM likely stems from the untested assumption that clients will use cash incentives to buy drugs or engage in other high-risk behaviors. This assumption is problematic for two reasons. First, the use of non-cash incentives adds substantial costs and complexity to CM protocols. Second, the use of non-cash incentives may reduce the efficacy of CM interventions, as research suggests that cash may be a more effective reinforcer than vouchers. This study will examine practical and ethical issues relating to cash-based CM procedures. We are proposing to conduct a 3-group randomized study comparing the efficacy, cost-effectiveness, and ethics of a (1) voucher-based CM intervention, (2) cash-based CM intervention, and (3) non-CM intervention. Consenting cocaine-dependent clients attending a community outpatient treatment program will be randomly assigned to each condition in equal proportions. This study will measure outcomes related to (1) efficacy, including UDS confirmed abstinence and counseling attendance; (2) cost-effectiveness; and (3) ethics, including the effects on intrinsic motivation, drug use, and other high-risk behavior. This study will be the first to examine the differential efficacy, cost-effectiveness, and ethics of a cash- versus a voucher-based CM protocol in the treatment of drug dependence. This investigation not only will address practical issues pertaining to the transfer of CM interventions into community-based treatment programs, but also will begin to shed empirical light on many of the ethical criticisms that have been levied against the use of cash and CM interventions.

描述（由申请人提供）：应急管理（CM）是针对药物滥用和依赖的一种明显有效的干预措施。大量实证研究支持其在提高治疗就诊率和戒毒率方面的功效。尽管 CM 协议采用了各种强化手段，但它们几乎完全依赖于非现金特权（例如带回家的美沙酮剂量）、奖品或可兑换商品或服务的代金券。尽管CM得到了强有力的实证支持，但我们的研究表明，对其成本和安全性的担忧（例如，奖励破坏内在动机或被出售以购买药物所造成的潜在危害）阻碍了其向现实世界实践的转移。专门使用非现金 CM 可能源于未经检验的假设，即客户将使用现金激励来购买药品或从事其他高风险行为。由于两个原因，这个假设是有问题的。首先，非现金激励的使用增加了 CM 协议的大量成本和复杂性。其次，使用非现金激励措施可能会降低 CM 干预措施的效果，因为研究表明现金可能是比代金券更有效的强化剂。本研究将探讨与基于现金的 CM 程序相关的实际和道德问题。我们建议进行一项 3 组随机研究，比较 (1) 基于凭证的 CM 干预、(2) 基于现金的 CM 干预和 (3) 非 CM 干预的功效、成本效益和伦理。同意参加社区门诊治疗计划的可卡因依赖者将被按相同比例随机分配到每种情况。这项研究将衡量与 (1) 功效相关的结果，包括 UDS 确认的戒酒和咨询出席率； (2)成本效益； (3) 道德，包括对内在动机、吸毒和其他高风险行为的影响。这项研究将首次检验现金与凭单基础的 CM 方案在药物依赖治疗中的功效、成本效益和伦理差异。这项调查不仅将解决与将 CM 干预措施转移到社区治疗计划相关的实际问题，还将开始对针对使用现金和 CM 干预措施提出的许多伦理批评提供实证依据。

项目成果

Contingency management for cocaine treatment: cash vs. vouchers.

可卡因治疗的应急管理：现金与代金券。

• 发表时间: 2014-08
• 影响因子: 3.9
• 作者: Festinger, David S;Dugosh, Karen L;Kirby, Kimberly C;Seymour, Brittany L
• 通讯作者: Seymour, Brittany L

Prize-based contingency management for the treatment of substance abusers: a meta-analysis.

用于治疗药物滥用者的基于奖励的应急管理：荟萃分析。

• 发表时间: 2014-09
• 作者: Benishek, Lois A;Dugosh, Karen L;Kirby, Kim C;Matejkowski, Jason;Clements, Nicolle T;Seymour, Brittany L;Festinger, David S
• 通讯作者: Festinger, David S