Contingency Management for Cocaine Dependence: Cash vs Vouchers

描述（由申请人提供）：应急管理（CM）是一种对药物滥用和依赖的有效干预措施。大量实证研究支持其在增加治疗出勤率和戒毒方面的功效。尽管CM协议已经采用了各种各样的授权，但是它们几乎完全依赖于非现金特权（例如，可带回家的美沙酮剂量）、奖品或可兑换商品或服务的代金券。尽管CM有强有力的经验支持，但我们的研究表明，与其成本和安全性相关的担忧（例如，奖励可能造成伤害，破坏内在动机或被出售购买毒品），阻碍了将其转移到现实世界的做法。专门使用非现金CM可能源于未经检验的假设，即客户将使用现金奖励购买毒品或从事其他高风险行为。这个假设有两个问题。首先，非现金激励的使用增加了CM协议的大量成本和复杂性。第二，使用非现金激励可能会降低CM干预措施的有效性，因为研究表明，现金可能比代金券更有效。这项研究将探讨与现金为基础的CM程序有关的实际和道德问题。我们建议进行一项3组随机研究，比较（1）基于代金券的CM干预，（2）基于现金的CM干预和（3）非CM干预的疗效，成本效益和伦理。参加社区门诊治疗计划的可卡因依赖者将被随机分配到每种条件下，比例相等。本研究将测量与以下方面相关的结果：（1）疗效，包括UDS确认的禁欲和咨询出勤率;（2）成本效益;（3）伦理，包括对内在动机、药物使用和其他高风险行为的影响。这项研究将是第一个检查的差异疗效，成本效益和道德的现金与凭证为基础的CM协议在治疗药物依赖。这项调查不仅将解决有关的CM干预转移到社区为基础的治疗方案的实际问题，但也将开始，以揭示经验的光对许多道德的批评，已被征收对使用现金和CM干预。

DESCRIPTION (provided by applicant): Contingency management (CM) is a demonstrably efficacious intervention for substance abuse and dependence. Substantial empirical research supports its efficacy in increasing treatment attendance and drug abstinence. Although CM protocols have employed a variety of reinforcers, they have almost exclusively relied upon non-cash privileges (e.g., take-home methadone doses), prizes, or vouchers that can be exchanged for goods or services. Despite the strong empirical support for CM, our research suggests that concerns relating to its cost and safety (e.g., potential for harm caused by rewards undermining intrinsic motivation or being sold to purchase drugs) have hindered its transfer to real-world practice. The exclusive use of non-cash CM likely stems from the untested assumption that clients will use cash incentives to buy drugs or engage in other high-risk behaviors. This assumption is problematic for two reasons. First, the use of non-cash incentives adds substantial costs and complexity to CM protocols. Second, the use of non-cash incentives may reduce the efficacy of CM interventions, as research suggests that cash may be a more effective reinforcer than vouchers. This study will examine practical and ethical issues relating to cash-based CM procedures. We are proposing to conduct a 3-group randomized study comparing the efficacy, cost-effectiveness, and ethics of a (1) voucher-based CM intervention, (2) cash-based CM intervention, and (3) non-CM intervention. Consenting cocaine-dependent clients attending a community outpatient treatment program will be randomly assigned to each condition in equal proportions. This study will measure outcomes related to (1) efficacy, including UDS confirmed abstinence and counseling attendance; (2) cost-effectiveness; and (3) ethics, including the effects on intrinsic motivation, drug use, and other high-risk behavior. This study will be the first to examine the differential efficacy, cost-effectiveness, and ethics of a cash- versus a voucher-based CM protocol in the treatment of drug dependence. This investigation not only will address practical issues pertaining to the transfer of CM interventions into community-based treatment programs, but also will begin to shed empirical light on many of the ethical criticisms that have been levied against the use of cash and CM interventions.