CONTINGENCY MANAGEMENT FOR REAL-LIFE DRUG TREATMENT

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Despite research demonstrating the efficacy and patient acceptability of voucher-based contingency management (CM) interventions for reducing drug use, community providers have been slow to adopt these procedures. One barrier to adoption of CM procedures is the high cost of supporting such programs. However, novel approaches using community- or user-supported services to reinforce drug abstinence or other target behaviors may offer a solution for financing CM programs. The specific aims of this proposal are to evaluate Contingent Fee Rebates and a Community-Sponsored Voucher Program, two innovative and potentially cost-effective CM strategies for use in community-based drug treatment programs. This project's goal is to make the robust success revealed by voucher-based contingency-management research practical enough for widespread testing and adoption by community-based practitioners. These strategies will be examined in three publicly-funded clinics within a large, urban, outpatient substance abuse service in Denver, CO. Four controlled studies will evaluate the use of these techniques with a range of substance abusers, including dually-diagnosed, pregnant, HIV-positive populations and children to increase the generality of our findings. Studies 1-3 will provide an examination of Contingent Fee Rebates for improving treatment outcomes among methadone-and LAAM-maintained outpatients. Study 4 will evaluate a community-sponsored voucher program for reducing smoking and other drug use among pregnant substance abusers using an incentive store stocked by community and manufacturer donations. Establishing a community-sponsored voucher program reinforces the role of the community in substance abuse treatment. The proposed research will use different CM strategies to elucidate the most practical and effective reinforcement schedules (fixed vs. variable) and the optimal target behaviors to reinforce (drug use vs. counseling attendance). Studies will be integrated into the existing structure of clinical programs to demonstrate the feasibility of transferring the CM procedures to existing community-based programing. Behavioral interventions will be delivered in conjunction with pharmacological adjuncts available at each site. The impact of our interventions on reducing AIDS risk behaviors will also be assessed. Finally, throughout the five years of this proposal, we will train new practitioners in the use of these strategies and work with NIDA to create training materials such as manuals, software, videos and detailed fundraising strategies for dissemination to clinicians and policy makers. Overall, these studies will guide practitioners in the use of CM for real-life drug abuse treatment.