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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1034 — Rewarding Early Abstinence and Treatment Participation (REAP): The Effect of Motivational Incentives on Substance Use Disorders Treatment Outcomes

Hagedorn HJ (Substance Use Disorders QUERI; Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System; University of Minnesota), Noorbaloochi S (Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System; University of Minnesota), Rimmele C (VA Puget Sound Health Care System; University of Washington), Kivlahan D (VA Puget Sound Health Care System; University of Washington)

Objectives:
Investigate the impact of adding a motivational incentive intervention to existing VA substance use disorders (SUD) treatment on during-treatment and post-treatment outcomes.

Methods:
Participants were 330 veterans presenting for SUD treatment at the VAMCs in Minneapolis or Seattle with intake diagnoses of alcohol and/or stimulant dependence who were randomly assigned to 8-weeks of Usual Care (UC) or UC plus Motivational Incentives (MI). All participants were scheduled to meet with a research assistant twice/week to submit urine and breath samples. Participants randomized to MI drew tokens each time they submitted negative urine and breath screens; earning social reinforcement (Good Job!) or VA canteen vouchers of varying value ($1, $20, or $80). Follow-up assessments using a Timeline Follow-Back interview occurred at 2, 6 and 12 months after enrollment.

Results:
A generalized linear mixed model demonstrated a significant difference (p < .002) in patterns of intervention appointment attendance and test results over the 16 intervention visits, which was accounted for by higher appointment attendance (11.6 vs. 9.8, p = .001) and more drug-free tests (11.2 vs. 9.6, p = .003) in the MI group compared to the UC group. The longest documented period of abstinence during the intervention was significantly longer for MI participants (5.5 weeks) than for UC participants (4.5 weeks; p < .001). A significantly higher percentage of MI participants (42.4%) achieved 8 weeks of documented abstinence compared to UC participants (29.7%). Across conditions, participants demonstrated significant improvement in percent days abstinent compared to baseline at 2-, 6- and 12-month follow-ups. At 2 and 12 months, there were no significant between group differences while at 6 months, CM participants reported significantly more abstinent days (95%) compared to Usual Care (88%). Total cost of the MI intervention, including staff time, vouchers, and urine test cups, was $269 per patient.

Implications:
The MI intervention increased appointment attendance rates, increased the longest period of documented abstinence, and improved the likelihood of attaining 8 weeks of documented abstinence. Impact of the intervention on self-reported outcomes beyond the intervention period was limited.

Impacts:
The MI intervention is a low cost adjunctive intervention for SUD treatment that improves attendance rates and abstinence in early recovery.


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