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Published Online: 1 January 2013

Randomized Controlled Trial of Contingency Management for Stimulant Use in Community Mental Health Patients With Serious Mental Illness

Abstract

Awarding a chance to receive a prize in return for each stimulant-free urine sample reduces stimulant use in outpatients with serious mental illness and stimulant dependence. In a 3-month study of 176 patients with amphetamine, methamphetamine, or cocaine dependence, the cost of urine testing and reinforcers was $864 for each participant abstinent for 8 or more weeks, but the patients had only 14 total days of hospitalization, compared to 152 for patients in a control condition.

Abstract

Objective

The primary objective of this study was to determine whether contingency management was associated with increased abstinence from stimulant drug use in stimulant-dependent patients with serious mental illness treated in a community mental health center. Secondary objectives were to determine whether contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV risk behavior, and inpatient service utilization.

Method

A randomized controlled design was used to compare outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomly assigned to receive 3 months of contingency management for stimulant abstinence plus treatment as usual or treatment as usual with reinforcement for study participation only. Urine drug tests and self-report, clinician-report, and service utilization outcomes were assessed during the 3-month treatment period and the 3-month follow-up period.

Results

Although participants in the contingency management condition were significantly less likely to complete the treatment period than those assigned to the control condition (42% compared with 65%), they were 2.4 times (95% CI=1.9–3.0) more likely to submit a stimulant-negative urine test during treatment. Compared with participants in the control condition, they had significantly lower levels of alcohol use, injection drug use, and psychiatric symptoms and were one-fifth as likely as those assigned to the control condition to be admitted for psychiatric hospitalization during treatment. They also reported significantly fewer days of stimulant drug use during the 3-month follow-up.

Conclusions

When added to treatment as usual, contingency management is associated with large reductions in stimulant, injection drug, and alcohol use. Reductions in psychiatric symptoms and hospitalizations are important secondary benefits.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 94 - 101
PubMed: 23138961

History

Received: 19 December 2011
Revision received: 28 March 2012
Revision received: 14 June 2012
Revision received: 23 July 2012
Accepted: 13 August 2012
Published online: 1 January 2013
Published in print: January 2013

Authors

Details

Michael G. McDonell, Ph.D.
From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; and the College of Nursing, Washington State University, Spokane.
Debra Srebnik, Ph.D.
From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; and the College of Nursing, Washington State University, Spokane.
Frank Angelo, M.A.
From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; and the College of Nursing, Washington State University, Spokane.
Sterling McPherson, Ph.D.
From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; and the College of Nursing, Washington State University, Spokane.
Jessica M. Lowe, B.A.
From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; and the College of Nursing, Washington State University, Spokane.
Andrea Sugar, B.A.
From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; and the College of Nursing, Washington State University, Spokane.
Robert A. Short, Ph.D.
From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; and the College of Nursing, Washington State University, Spokane.
John M. Roll, Ph.D.
From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; and the College of Nursing, Washington State University, Spokane.
Richard K. Ries, M.D.
From the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; and the College of Nursing, Washington State University, Spokane.

Notes

Presented at the 22nd annual meeting and symposium of the American Academy of Addiction Psychiatry, Scottsdale, Ariz., December 8–11, 2011.
Address correspondence to Dr. McDonell ([email protected]).

Funding Information

Drs. McPherson and Roll have received research funding from the Bristol-Myers Squibb Foundation. Dr. Ries has been on the speakers bureaus of Alkermes and Janssen. The other authors report no financial relationships with commercial interests.
Supplementary Material
Supported by National Institute on Drug Abuse grant R01 DA022476-01 (principal investigator, Dr. Ries).

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