Contingency management in cocaine abusers: A dose-effect comparison of goods-based versus cash-based incentives
Contingency management in cocaine abusers: A dose-effect comparison of goods-based versus cash-based incentives
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DOI：
10.1037/1064-1297.15.4.338
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发表时间：
2007-08-01
影响因子：
2.3
通讯作者：
Stitzer, Maxine L.
中科院分区：
文献类型：
--
作者：
Vandrey, Ryan;Bigelow, George E.;Stitzer, Maxine L.
基于货物的应急管理干预措施（例如，那些使用代金券或奖品作为奖励的人）已证明在减少可卡因使用方面有效，但成本限制了向社区诊所的传播。最近的研究表明，开发基于现金的应急管理方法可能会改善治疗效果，同时降低干预的运营成本。然而，向药物滥用者提供现金奖励的临床安全性一直令人担忧。本项为期16周的研究比较了价值0美元、25美元、50美元和100美元的商品激励与现金激励对可卡因依赖性美沙酮患者（N = 12）短期可卡因戒断的影响。采用受试者内设计; 8个激励条件中的每一个都有9天的洗脱期。更高的幅度（50美元和100美元）的现金为基础的奖励（检查）产生更大的可卡因戒断相比，控制（0美元）的条件，但幅度的影响是没有看到基于商品的奖励（券）。在50美元和100美元的数量级上，观察到以现金为基础的奖励与以货物为基础的奖励相比，禁欲率更高的趋势。收到100美元的支票并没有增加随后的可卡因使用率高于控制条件下所看到的。本研究和其他近期研究中提供的疗效和安全性数据表明，在应急管理的临床应用中，值得考虑使用现金激励，但需要在使用更大样本和更长时间的激励交付的研究中进行额外的确认。
Goods-based contingency management interventions (e.g., those using vouchers or prizes as incentives) have demonstrated efficacy in reducing cocaine use, but cost has limited dissemination to community clinics. Recent research suggests that development of a cash-based contingency management approach may improve treatment outcomes while reducing operational costs of the intervention. However, the clinical safety of providing cash-based incentives to substance abusers has been a concern. The present 16-week study compared the effects of goods-based versus cash-based incentives worth $0, $25, $50, and $100 on short-term cocaine abstinence in a small sample of cocaine-dependent methadone patients (N = 12). A within-subject design was used; a 9-day washout period separated each of 8 incentive conditions. Higher magnitude ($50 and $100) cash-based incentives (checks) produced greater cocaine abstinence compared with the control ($0) condition, but a magnitude effect was not seen for goods-based incentives (vouchers). A trend was observed for greater rates of abstinence in the cash-based versus goods-based incentives at the $50 and $100 magnitudes. Receipt of $100 checks did not increase subsequent rates of cocaine use above those seen in control conditions. The efficacy and safety data provided in this and other recent studies suggest that use of cash-based incentives deserves consideration for clinical applications of contingency management, but additional confirmation in research using larger samples and more prolonged periods of incentive delivery is needed.