BACKGROUND/RATIONALE:
Previous research from multiple investigators has demonstrated the efficacy of Contingency Management (CM) interventions for reducing substance use and increasing treatment attendance and retention. However, only one small study with alcohol dependent veterans has demonstrated the effectiveness of CM interventions in the VA patient population. This trial of a CM intervention assessed the impact of CM on alcohol and stimulant dependent veterans during the intervention and 6 and 12 months after the intervention.

OBJECTIVE(S):
Investigate the impact of adding a CM intervention to existing VA treatment for drug and alcohol dependence on during-treatment and post-treatment patient outcomes

METHODS:
This was a randomized, controlled trial. Participants included 330 veterans presenting for specialty SUD treatment at the VAMCs in Minneapolis or Seattle with intake diagnoses of alcohol and/or stimulant dependence. Participants were assigned to 8-weeks of Usual Care or Usual Care plus CM and scheduled to meet with a research assistant twice/week to submit urine and breath samples. Participants randomized to CM drew tokens each time they submitted negative urine and breath screens. Tokens earned social reinforcement (Good Job!) or VA canteen vouchers of varying value ($1, $20, or $80). Follow-up assessments occurred 2, 6 and 12 months after enrollment into the study. Primary outcomes included number of days with negative urine drug and breath alcohol screens during the intervention phase, consecutive weeks of treatment attendance during the intervention phase, and self-reported percent days abstinent from alcohol and stimulants on the Timeline Follow-Back interview at follow-up assessments.

FINDINGS/RESULTS:
Participants randomly assigned to CM attended significantly more intervention appointments and submitted significantly more negative breath and urine screens than participants assigned to Usual Care. Consecutive weeks of usual care treatment attendance did not differ reliably between groups. Follow-up assessment rates did not differ significantly by condition and were obtained for 81%, 76% and 74% of participants at 2-, 6- and 12-months, respectively. At 2-month follow-up, both the Usual Care and the CM participants demonstrated significant improvement in percent days abstinent and these improvements were sustained at the 6- and 12-month follow-ups based on analyses with generalized estimating equations. At 2 months and 12 months, there were no significant between group differences. At 6 months, CM participants reported significantly more abstinent days out of the past 30 (95%) compared to Usual Care (88%). Service utilization data collected over the 12 months of study participation indicated no significant differences between CM and Usual Care in the number of SUD, mental health, and social work outpatient appointments, the number of Emergency Room visits, the number of inpatient mental health hospitalizations, or the number of days hospitalized for mental health issues.

IMPACT:
The CM intervention increased appointment attendance during treatment and modestly improved percent days abstinent at 6-month follow-up.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Hagedorn HJ, Stetler CB, Bangerter A, Noorbaloochi S, Stitzer ML, Kivlahan D. An implementation-focused process evaluation of an incentive intervention effectiveness trial in substance use disorders clinics at two Veterans Health Administration medical centers. Addiction science & clinical practice. 2014 Jul 9; 9(1):12. [view]
2. Hagedorn HJ, Noorbaloochi S, Bangerter A, Stitzer ML, Kivlahan D. Health care cost trajectories in the year prior to and following intake into Veterans Health Administration outpatient substance use disorders treatment. Journal of substance abuse treatment. 2017 Aug 1; 79:46-52. [view]
3. Hagedorn HJ, Noorbaloochi S, Simon AB, Bangerter A, Stitzer ML, Stetler CB, Kivlahan D. Rewarding early abstinence in Veterans Health Administration addiction clinics. Journal of substance abuse treatment. 2013 Jul 1; 45(1):109-17. [view]

VA Cyberseminars

1. Young A, Hagedorn HJ. Evaluation in Implementation Research: Examples and Challenges. [Cyberseminar]. 2011 May 12. [view]

Conference Presentations

1. Hagedorn H, Kilbourne AM, Damschroder LJ, Bauer M, Smith J. An Introduction to Implementation Science Theory and Methods: Application to Alcohol Use Disorders Treatment. Paper presented at: American Psychological Association Annual Convention; 2014 Aug 10; Washington, DC. [view]
2. Hagedorn HJ. Contingency Management/Motivational Incentives as Adjunctive Care for SUD. Presented at: VA Office of Mental Health Services, Implementing the Handbook on Uniform Mental Health Services: Empirically-Based Treatment for SUD Conference; 2009 Aug 1; New Orleans, LA. [view]
3. Hagedorn HJ, Noorbaloochi S, Rimmele C, Kivlahan D. Effectiveness of a Contingency Management Intervention for Veterans with Substance Use Disorders. Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL. [view]
4. Hagedorn HJ, Noorbaloochi S, Rimmele C, Kivalan D. Effectiveness of a Contingency Management Intervention for Veterans with Substance Use Disorders. Presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2009 Jul 1; Baltimore, MD. [view]
5. Bauer M, Curran G, Mittman B, Stetler C, Hagedorn HJ. Hybrid Effectiveness-Implementation Trial Designs for Enhanced Research Impact. Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD. [view]
6. Hagedorn HJ, Noorbaloochi S. Impact of an Incentive Program on Treatment Outcomes for Veterans with Alcohol or Stimulant Dependence. Paper presented at: AcademyHealth Annual Research Meeting; 2012 Jun 24; Orlando, FL. [view]
7. Hagedorn HJ, Kivlahan D. Implementation of an Incentive Program in VA: Perspectives from the Rewarding Early Abstinence and Treatment Participation (REAP) Study. Presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 28; Baltimore, MD. [view]
8. Hagedorn HJ. Implementing motivational incentive in VA substance use disorders treatment. Paper presented at: VA VISN 23 Mental Health Research Conference; 2011 May 5; Sioux Falls, SD. [view]
9. Hagedorn HJ, Noorbaloochi S, Rimmele CT, Kivlahan DR. Rewarding Early Abstinence and Treatment Participation (REAP): The Effect of Motivational Incentives on Substance Use Disorders Treatment Outcomes. Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; Baltimore, MD. [view]
10. Hagedorn HJ, Noorbaloochi S, Rimmele C, Kivlahan D. Rewarding Early Abstinence and Treatment Participation in Substance Use Disorders Treatment. Poster session presented at: AcademyHealth Annual Research Meeting; 2010 Jun 28; Boston, MA. [view]
11. Hagedorn HJ. Rewarding Early Abstinence and Treatment Participation: the effect of motivational incentives on substance use disorders treatment outcomes. Paper presented at: AcademyHealth Annual Research Meeting; 2011 Jun 14; Seattle, WA. [view]

DRA: Substance Use Disorders, Health Systems Science
DRE: none
Keywords: Alcohol, Behavior (patient), Drug abuse
MeSH Terms: none