Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment - A national drug abuse treatment clinical trials network study

Background: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence have improved treatment outcomes of substance abusers, but have not been widely implemented in community drug abuse treatment settings. Objective: To compare outcomes achieved when a lower-cost prize-based contingency management treatment is added to usual care in community methadone hydrochloride maintenance treatment settings. Design: Random assignment to usual care with (n = 198) or without (n = 190) abstinence incentives during a 12-week trial. Setting: Six community-based methadone maintenance drug abuse treatment clinics in locations across the United States. Participants: Three hundred eighty-eight stimulant-abusing patients enrolled in methadone maintenance programs for at least 1 month and no more than 3 years. Intervention: Participants submitting stimulant- and alcohol-negative samples earned draws for a chance to win prizes; the number of draws earned increased with continuous abstinence time. Main Outcome Measures: Total number of stimulant- and alcohol-negative samples provided, percentage of stimulant- and alcohol-negative samples provided, longest duration of abstinence, retention, and counseling attendance. Results: Submission of stimulant- and alcohol-negative samples was twice as likely for incentive as for usual care group participants (odds ratio, 1.98; 95% confidence interval, 1.42-2.77). Achieving 4 or more, 8 or more, and 12 weeks of continuous abstinence was approximately 3, 9, and 11 times more likely, respectively, for incentive vs usual care participants. Groups did not differ on study retention or counseling attendance. The average cost of prizes was $120 per participant. Conclusion: An abstinence incentive approach that paid $120 in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.