Contingency management delivered by community therapists in outpatient settings

Abstract

Background: Few community-based clinicians have been trained to deliver contingency management (CM) treatments, and little data exist regarding the efficacy of CM when administered by clinicians.

Method: Fifteen clinicians from four intensive outpatient treatment programs received training in CM. Following a didactics seminar and a period in which clinicians delivered CM to pilot patients while receiving weekly supervision, clinicians treated 43 patients randomized to standard care or CM, without supervision. In both treatment conditions, urine and breath samples were collected up to twice weekly for 12 weeks, and CM patients earned the opportunity to win prizes ranging in value from $1 to $100 for submitting drug-free samples. Primary treatment outcomes were sessions attended, unexcused absences, longest continuous period of abstinence, and proportion of negative samples submitted.

Results: All therapists completed the training and supervision phase, and 10 treated randomized patients. Patients randomized to CM achieved significantly greater durations of abstinence than patients randomized to standard care (5.0±3.8 weeks versus 2.6±3.7 weeks) and had fewer unexcused absences (4.3±1.2 versus 8.1±5.4), but proportion of negative samples submitted and attendance did not differ significantly between groups. Therapist adherence and competence in CM delivery decreased when supervision was no longer provided, and competence in CM delivery was associated with duration of abstinence achieved and attendance.

Conclusions: Community-based clinicians can effectively administer CM, and outcomes relate to competence in CM delivery. These data call for further training and supervision of community clinicians in this evidence-based treatment.