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The Evolution of a Treatment Approach: Treatment Outcome Studies on Contingency Management and SUDs

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As is typical of treatment development, early reports on the use of CM to treat SUDs first appeared in the form of uncontrolled case studies in which, for example, smokers earned back portions of a monetary deposit contingent on remaining abstinent from smoking, amphetamine abusers earned retail items donated by community businesses contingent on drug abstinence, or individuals with chronic alcoholic dependence earned coupon booklets contingent on submitting alcohol-negative breath specimens. A particularly impressive seminal controlled study in this area was reported by Miller (1975). In this study, 20 homeless men with severe alcohol dependence were randomly assigned to a control condition or CM intervention. Those in the control condition received the usual social services in the form of food, clothing, and housing, while those in the CM condition received those same services as long as they sustained abstinence, verified through breath alcohol testing and observation of signs of gross intoxication. Evidence of drinking resulted in a 5-day suspension from such services. Arrests for public drunkenness decreased and days of employment increased among those in the contingent condition compared with the control condition.

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FIGURE 27–1. Estimated effect size (r) and 95% confidence intervals.Weighted average effect sizes and 95% confidence intervals for subsets of studies as a function of the moderator variables: target, control condition, duration, daily earnings, voucher-based reinforcement therapy (VBRT) delivery immediacy, setting, and study quality. All studies target abstinence (N = 30). Weighted average effect sizes are represented by closed diamonds and 95% confidence intervals by solid lines. Where confidence intervals do not overlap, differences between subsets of studies are significantly different at the 0.05 level.Source. Reprinted from Lussier JP, Heil SH, Mongeon JA, et al: "A Meta-Analysis of Voucher-Based Reinforcement Therapy for Substance Use Disorders." Addiction 101:192–203, 2006. Used with permission.

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