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Prize Incentives Contingency Management for Substance Abuse

Prize Incentives Contingency Management for Substance Abuse is a variation of contingency management, or reinforcement, that awards prizes for abstinence and treatment compliance. It is based on a construct central to behavioral psychology known as operant conditioning, or the use of consequences to modify the occurrence and form of behavior. The program augments existing, usual care services in community-based treatment settings for adults who primarily abuse stimulants (especially cocaine) or opioids (especially heroin) or who have multiple substance use problems. Over a period of 3 months, urine and breath samples are collected two or three times a week for at least the first 6 weeks and once or twice weekly thereafter. For each sample that tests negative for the target drug (stimulants or opioids), clients can draw slips of paper or plastic chips from a bowl for the chance of winning a prize valued from $1 to $100. Clients may also receive draws from the prize bowl for attending counseling/group therapy sessions and completing weekly goal-related activities. The number of draws from the prize bowl increases from 1 to as many as 15 with consecutive negative test results and/or attendance at consecutive sessions. A drug-positive sample or an unexcused absence resets the number of draws to one. Bonus draws may be awarded to clients on a predetermined schedule. Although the original trials of Prize Incentives were conducted over 3 months, the intervention can be used with urine and breath samples collected one to three times weekly for longer durations.

Descriptive Information

Areas of Interest	Substance abuse treatment
Outcomes	Review Date: August 2007 1: Drug use during treatment 2: Drug use after treatment 3: Drug problem severity during and after treatment 4: Quality of life 5: Treatment retention 6: Group/counseling attendance
Outcome Categories	Alcohol Drugs Quality of life Treatment/recovery
Ages	26-55 (Adult)
Genders	Male Female
Races/Ethnicities	Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	Outpatient Other community settings
Geographic Locations	Urban Suburban
Implementation History	The intervention has been evaluated with about 1,750 clients at 42 community-based drug treatment programs focusing on stimulant and opioid abuse and dependence. Twenty-eight of these programs were in the New England area, and 14 were nationwide as part of the Motivational Incentives for Enhanced Drug Abuse Recovery (MIEDAR) project supported by the Clinical Trials Network (CTN) of the National Institute on Drug Abuse. Positive outcomes and lessons learned from the MIEDAR project became the basis for the Promoting Awareness of Motivational Incentives (PAMI) Tool Package, which is available on the PAMI Web site: http://nattc.org/pami/pami_home.html. Another product that evolved out of the MIEDAR project is the manual Contingency Management: Using Motivational Incentives To Improve Drug Abuse Treatment.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	IOM prevention categories are not applicable.

Quality of Research

Review Date: August 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Supplementary Materials

Hanson, T., Alessi, S. M., & Petry, N. M. (2007). Contingency management reduces HIV risk behaviors in cocaine-abusing methadone patients. Unpublished manuscript.

Killeen, T., Carter, R., Copersino, M., Petry, N., & Stitzer, M. (2007). Effectiveness of motivational incentives in stimulant abusing outpatients with different treatment histories. American Journal of Drug and Alcohol Abuse, 33(1), 129-137.

Ledgerwood, D. M., & Petry, N. M. (2006). Does contingency management affect motivation to change substance use? Drug and Alcohol Dependence, 83(1), 65-72.

Olmstead, T. A., Sindelar, J. L., & Petry, N. M. (2007). Cost-effectiveness of prize-based incentives for stimulant abusers in outpatient psychosocial treatment programs. Drug and Alcohol Dependence, 87(2-3), 175-182.

McQuaid, F., & Bowden-Jones, O., & Weaver, T. (2007). Contingency management for substance misuse [Correspondence]. British Journal of Psychiatry, 190, 272.

Petry, N. M. (2006). Contingency management treatments [Editorial]. British Journal of Psychiatry, 189, 97-98.

Petry, N. M. (2007). Contingency management for substance misuse [Author's reply]. British Journal of Psychiatry, 190, 272.

Petry, N. M. (2007). Serious adverse events in psychosocial treatment studies: Safety or arbitrary edicts? Unpublished manuscript.

Petry, N. M., Alessi, S. M., Carroll, K. M., Hanson, T., MacKinnon, S., Rounsaville, B., et al. (2006). Contingency management treatments: Reinforcing abstinence versus adherence with goal-related activities. Journal of Consulting and Clinical Psychology, 74(3), 592-601.

Petry, N. M., Kolodner, K. B., Li, R., Peirce, J. M., Roll, J. M., Stitzer, M. L., et al. (2006). Prize-based contingency management does not increase gambling. Drug and Alcohol Dependence, 83(3), 269-273.

Petry, N. M., & Martin, B. (2002). Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients. Journal of Consulting and Clinical Psychology, 70(2), 398-405.

Petry, N. M., Martin, B., Cooney, J. L., & Kranzler, H. R. (2000). Give them prizes, and they will come: Contingency management for treatment of alcohol dependence. Journal of Consulting and Clinical Psychology, 68(2), 250-257.

Roll, J. M., Petry, N. M., Stitzer, M. L., Brecht, M. L., Peirce, J. M., McCann, M. J., et al. (2006). Contingency management for the treatment of methamphetamine use disorders. American Journal of Psychiatry, 163(11), 1993-1999.

Sindelar, J., Elbel, B., & Petry, N. M. (2007). What do we get for our money? Cost-effectiveness of adding contingency management. Addiction, 102(2), 309-316.

Stitzer, M. L., Peirce, J., Petry, N. M., Kirby, K., Roll, J., Krasnansky, J., et al. (2007). Abstinence-based incentives in methadone maintenance: Interaction with intake stimulant test results. Experimental and Clinical Psychopharmacology, 15(4), 344-350.

Stitzer, M. L., Petry, N. M., Peirce, J., Kirby, K., Killeen, T., Roll, J., et al. (2007). Effectiveness of abstinence-based incentives: Interaction with intake stimulant test results. Journal of Consulting and Clinical Psychology, 75(5), 805-811.

Tracy, K., Babuscio, T., Nich, C., Kiluk, B., Carroll, K. M., Petry, N. M., et al. (2007). Contingency management to reduce substance use in individuals who are homeless with co-occurring psychiatric disorders. American Journal of Drug and Alcohol Abuse, 33(2), 253-258.

Outcomes

Outcome 1: Drug use during treatment
Description of Measures	Drug use during treatment was measured using urinalysis (OnTrak TesTstik or OnTrak TesTcup 5) with or without accompanying breath analysis for blood alcohol concentration (Alcosensor IV Alcometer). Across a 3-month treatment period, collected urine/breath samples were tested for the presence of cocaine, opioids, and alcohol; cocaine and opioids; or stimulants (cocaine, methamphetamine, amphetamine) and alcohol.
Key Findings	Across five randomized controlled trials (RCTs) conducted in clinical and community-based settings, prize incentives were more effective than usual care conditions in improving abstinence from drug use during treatment. When different prize levels were compared, greater results were seen for higher-valued prize incentives over lesser-valued prize incentives. In two community-based treatment centers serving cocaine-abusing outpatients: Usual care (weekly counseling) was compared with usual care plus prize incentives. Two levels of prize incentives were evaluated: an $80 and $240 maximum. Patients receiving $240 in prize incentives abstained from cocaine, opioids, and alcohol for longer periods compared with patients receiving usual care (p < .05). Patients receiving $240 in prize incentives had a higher percentage of drug-free samples (84.2%) than patients in usual care (62.3%, p < .01) and those receiving the $80 prize incentives (66.4%, p < .05). When the $80 prize incentive condition was compared with usual care, no significant differences were seen in the longest duration of abstinence or in average percentage of drug-free samples. In a community clinic serving cocaine-dependent methadone patients: Usual care (methadone and weekly group therapy) was compared with usual care plus escalating prize incentives (up to 15 prize draws per consecutive urine sample testing negative for cocaine and opioids). Prize incentive participants were continuously abstinent for 2.9 weeks on average compared with only 0.8 weeks for usual care participants (p < .05). Prize incentive participants had a higher percentage of cocaine-negative urine samples compared with patients receiving usual care (34.6% vs. 16.8%, p < .01). Opioid-negative urine samples did not differ between the prize incentive and usual care groups. In three community-based treatment centers serving cocaine- or heroin-dependent outpatients: Usual care (intensive individual and group therapy) was compared with usual care plus prize or voucher incentives. Participants receiving prize incentives achieved an average of 7.8 weeks of abstinence from cocaine, heroin, and alcohol, compared with 7.0 weeks for participants receiving voucher incentives and only 4.6 weeks for usual care participants. The longest duration of drug abstinence achieved by the usual care group was significantly shorter compared with that achieved by the prize (p < .01) or the voucher (p < .01) incentive groups; the duration did not differ between the two incentive conditions. This difference between the prize incentive and usual care conditions was associated with a small effect size (Cohen's d = 0.42), as was the difference between the voucher incentive and usual care conditions (Cohen's d = 0.29). Forty-five percent of prize incentive patients were abstinent for the entire 3 months, compared with 28% in the voucher incentive group (p < .01) and only 8% in the usual care group. The 8% rate of drug abstinence in the usual care condition was significantly lower than the rates for patients in either the prize (p < .01) or the voucher (p = .02) incentive conditions. In eight nationwide community-based outpatient psychosocial treatment programs serving cocaine or methamphetamine users: Usual care (primarily group therapy with some individual and family counseling) was compared with usual care plus escalating prize incentives (up to 12 draws per negative consecutive urine/breath sample). On average, prize incentive participants achieved 4.4 weeks of abstinence from stimulants (cocaine, methamphetamines, amphetamines) and alcohol, compared with 2.6 weeks for usual care participants (p < .001). Nearly twice as many prize incentive participants (39.7%) achieved sustained drug abstinence for at least 1 month compared with those receiving usual care (21.0%), a difference representing a small effect size (odds ratio = 2.48). Another 26.3% of prize incentive participants achieved drug abstinence for at least 2 months compared with 11.7% of the usual care group, a difference that also represents a small effect size (odds ratio = 2.69). A medium effect size (odds ratio = 4.48) was found when examining 3 months of sustained abstinence, achieved by 18.7% of the prize incentive group but only 4.9% of the usual care group. Prize incentive participants were more likely to submit 19-24 consecutive negative samples compared with usual care patients (p < .001). In six nationwide community-based methadone maintenance clinics serving stimulant-abusing patients: Usual care (methadone with group and some individual counseling) was compared with usual care plus escalating prize incentives (up to 12 draws per negative consecutive urine/breath sample). Prize incentive participants, who had an average of 3 weeks of continuous abstinence, were twice as likely to submit stimulant- and alcohol-negative samples as usual care participants, who had an average of 1 week of continuous abstinence (p < .001). Prize incentive participants were 3 times more likely than usual care participants to achieve abstinence for 1 or more months, 9 times more likely to achieve abstinence for 2 or more months, and 11 times more likely to achieve abstinence for 3 full months (odds ratio = 3.1, 9.3, and 11.1, respectively). The effect sizes associated with these differences were medium (1 month) or large (2 and 3 months). Prize incentive participants were more likely to submit 19-24 consecutive negative samples (21.2%) than usual care participants (8.0%) (p < .001).
Studies Measuring Outcome	Study 1, Study 2, Study 3, Study 5, Study 6
Study Designs	Experimental
Quality of Research Rating	3.8 (0.0-4.0 scale)

Outcome 2: Drug use after treatment
Description of Measures	In one study, cocaine use after treatment was measured using urinalysis (OnTrak TesTstik) at two time points: at study end (3 months after intake) and 3 months later (6 months after intake). The second study used urinalysis (OnTrak TesTstik) and breath analysis (Alcosensor IV Alcometer) at 3 (study end), 6, and 9 months after intake to test for cocaine, opioids, and alcohol. This study additionally matched the combined urinalysis and breath analysis results with self-reported drug use measured by the Addiction Severity Index (ASI). The ASI is an interview instrument that evaluates the severity of psychosocial problems across employment, family/social, legal, drug, alcohol, medical, and psychiatric domains. Composite scores of 0 to 1 are generated for each domain, with higher scores reflecting greater problem severity. Drug use (indicated by positive urinalysis) at intake was used to predict abstinence from cocaine at the 6-month follow-up (first study) and abstinence from cocaine, opioids, and alcohol at the 6- and 9-month follow-ups (second study).
Key Findings	In one of two RCTs conducted in clinical and community-based settings, prize incentives were more effective than usual care conditions in improving abstinence from drug use after treatment. In a community clinic serving cocaine-dependent methadone patients: Usual care (methadone and weekly group therapy) was compared with usual care plus escalating prize incentives (up to 15 prize draws per consecutive urine sample testing negative for cocaine and opioids). Prize incentive participants submitted a higher percentage of cocaine-negative samples at the 3- and 6-month follow-ups than patients receiving usual care (29.7% vs. 11.1%, p < .02). Six months after study initiation, 35.5% of the prize incentive participants submitted cocaine-negative samples compared with only 13.5% of the usual care participants (p < .05), with a high association between the negative clinic-requested samples and the negative study-requested samples across follow-up (p < .001). Longest duration of abstinence from cocaine during treatment correctly predicted 79.4% of the patients who would provide a cocaine-negative sample at 6 months (p < .01), but the effect size was very small (odds ratio = 1.26). In three community-based treatment centers serving cocaine- or heroin-dependent outpatients: Usual care (intensive individual and group therapy) was compared with usual care plus prize or voucher incentives. Self-reported use of cocaine, opioids, and alcohol and results from urinalysis and breath analysis were highly consistent, with less than 7% of patients denying use that was confirmed by positive samples. There were no differences in self-reported drug use between the prize incentive, voucher incentive, and usual care groups at the 6-month follow-up. Weeks of confirmed drug abstinence (based on both self-report and the analysis of samples) correctly predicted 72.6% of drug-abstinent patients at the 6-month (p < .001) and 9-month (p < .001) follow-ups, but the effect size was very small (odds ratio = 0.80 at 6 months, odds ratio = 0.76 at 9 months).
Studies Measuring Outcome	Study 2, Study 3
Study Designs	Experimental
Quality of Research Rating	3.8 (0.0-4.0 scale)

Outcome 3: Drug problem severity during and after treatment
Description of Measures	Drug problem severity during and after treatment was measured using composite scores from the drug, cocaine, and medical subscales of the ASI. Two studies administered the ASI at intake and at 3 (study end) and 6 months after intake; the second study also collected data at 9 months after intake. The ASI is an interview instrument that evaluates the severity of psychosocial problems across seven life domains. Composite scores of 0 to 1 are calculated for each domain subscale, with higher scores reflecting greater problem severity.
Key Findings	In one of two RCTs conducted in clinical and community-based settings, prize incentives were more effective than usual care conditions in minimizing drug problem severity during and after treatment. In a community clinic serving cocaine-dependent methadone patients: Usual care (methadone and weekly group therapy) was compared with usual care plus escalating prize incentives (up to 15 prize draws per consecutive urine sample testing negative for cocaine and opioids). Prize incentive participants showed a decrease in the drug (p < .05), cocaine (p < .05), and medical (p < .01) composite scores of the ASI from intake to 3 months and intake to 6 months. This decrease over time was absent in the patients receiving usual care only. In three community-based treatment centers serving cocaine- or heroin-dependent outpatients: Usual care (intensive individual and group therapy) was compared with usual care plus prize or voucher incentives. Patients in all three study groups--prize incentive, voucher incentive, and usual care--experienced decreases in ASI scores for drug, employment, legal, and psychiatric problems from intake to 3 months and intake to 9 months (p < .01). The only improvement that was greater for participants in the prize incentive condition relative to those in the voucher condition was the drug subscale score from intake to 3 months (p < .05).
Studies Measuring Outcome	Study 2, Study 3
Study Designs	Experimental
Quality of Research Rating	3.7 (0.0-4.0 scale)

Outcome 4: Quality of life
Description of Measures	Quality of life was evaluated using the Quality of Life Inventory (QOLI), a brief, self-administered instrument that assesses the importance of and satisfaction within 17 life area domains. A subscale score is derived for each domain, with a total scale score obtained by averaging all subscale scores for domains rated either "important" or "extremely important" by the individual. The QOLI was administered at intake and at 1, 3 (study end), 6, and 9 months after intake. The QOLI scores were compared with the longest duration of abstinence from cocaine, opioids, and alcohol achieved during the study period, as measured by urinalysis and breath analysis.
Key Findings	In three clinical RCTs involving cocaine abusers: Usual care (intensive outpatient group and individual therapy sessions) was compared with usual care plus prize or voucher incentives. Participants in the incentive (prize or voucher) conditions showed significant increases in posttreatment QOLI scores over time (p = .01), but participants receiving usual care did not. QOLI score improvements in the incentive conditions were highest for participants who also achieved the longest durations (2-3 months) of drug abstinence (p < .05). The association between QOLI scores and longest duration of abstinence at 3 months (p < .001), 6 months (p < .05), and 9 months (p < .01) posttreatment was significant across the entire patient sample, even after controlling for baseline score differences. Longest duration of abstinence was a significant predictor (p = .03) of the rate of change (improvement or decline) in QOLI scores over time across the entire patient sample.
Studies Measuring Outcome	Study 4
Study Designs	Experimental
Quality of Research Rating	3.6 (0.0-4.0 scale)

Outcome 5: Treatment retention
Description of Measures	One study defined treatment retention as the number of weeks that patients were retained in treatment. Two other studies measured the number of days that elapsed between the first and last submitted urine samples across the 3-month study period. Study compliance, evaluated as part of the treatment retention outcome, was defined by the percentage of participants who submitted at least one sample per week during the study.
Key Findings	In two of three RCTs conducted in clinical and community-based settings, prize incentives were more effective than usual care conditions in retaining patients in treatment. In three community-based treatment centers serving cocaine- or heroin-dependent outpatients: Usual care (intensive individual and group therapy) was compared with usual care plus prize or voucher incentives. On average, prize incentive participants were retained for 9.3 weeks; voucher incentive participants, 8.2 weeks; and usual care participants, 5.5 weeks. The difference in retention between the usual care condition and each of the two incentive conditions was significant (p < .01 for both comparisons), but retention did not differ significantly between the two incentive conditions. Treatment retention across the three clinics showed similar trends, but only two of the three clinics had significant outcomes (p < .05). The overall effect size for the difference in treatment retention between the usual care and prize incentive conditions was medium (Cohen's d = 0.52) and reflected effect sizes that ranged from small (Cohen's d = 0.44) to medium (Cohen's d = 0.57) across the three clinics. The overall effect size for the difference in treatment retention between the usual care and the voucher incentive conditions was small (Cohen's d = 0.38) and reflected effect sizes that ranged from very small (Cohen's d = 0.17) to medium (Cohen's d = 0.56). Only the incentive conditions were significantly related to retention (p = .03). In eight nationwide community-based outpatient psychosocial treatment programs serving cocaine or methamphetamine users: Usual care (primarily group with some individual and family counseling) was compared with usual care plus escalating prize incentives (up to 12 draws per negative consecutive urine/breath sample). Prize incentive and usual care participants initially showed a 10% decline in treatment retention; this decline resulted from some patients not returning after the first study visit. Prize incentive participants were more likely to be retained in treatment (49%) than usual care participants (35%) at the end of the 3-month study. Prize incentive participants were more likely to submit urine/breath samples than usual care participants (an average of 12.9 vs. 9.9 samples, respectively, p < .001), but this difference was associated with a small effect size (odds ratio = 1.56). Average weeks retained in treatment showed a similar trend as individual samples submitted but only reached statistical significance at two of the eight treatment sites. In six nationwide community-based methadone maintenance clinics serving stimulant-abusing patients: Usual care (methadone with group and some individual counseling) was compared with usual care plus escalating prize incentives (up to 12 draws per negative consecutive urine/breath sample). Prize incentive participants were about as likely as usual care participants to be retained in treatment for the full 3 months (67% vs. 65%). During the 3 months of study, prize incentive participants submitted an average of 15.5 samples compared with 14.1 samples submitted by usual care participants, a difference that reflects a very small effect size (odds ratio = 1.2).
Studies Measuring Outcome	Study 3, Study 5, Study 6
Study Designs	Experimental
Quality of Research Rating	3.9 (0.0-4.0 scale)

Outcome 6: Group/counseling attendance
Description of Measures	Group/counseling attendance was evaluated using both the number of therapy sessions attended and the percentage of patients attending therapy groups over the 3-month study period.
Key Findings	Across two RCTs conducted in clinical and community-based settings, prize incentives were more effective than usual care conditions in facilitating group/counseling attendance. In a community clinic serving cocaine-dependent methadone patients: Usual care (methadone and weekly group therapy) was compared with usual care plus prize incentives. Patients in both groups received a single prize draw for attending group sessions, but prize incentive participants additionally received escalating prizes for attending consecutive sessions. Both weekly group therapy attendance and percentage of patients attending groups were higher for the prize incentive condition compared with the usual care condition (p < .001). Prize incentive participants attended group therapy sessions for an average of 6.6 weeks compared with 3.0 weeks for usual care participants. For prize incentive participants, the number of groups attended was associated with weeks of continuous cocaine abstinence (p < .001). There was no relationship between therapy group attendance and abstinence among usual care participants. In eight nationwide community-based outpatient psychosocial treatment programs serving cocaine or methamphetamine users: Usual care (primarily group therapy with some individual and family counseling) was compared with usual care plus escalating prize incentives. Over the 3-month study period, prize incentive participants attended more group/counseling sessions than usual care participants (19.2 vs. 15.7, p < .02). Adjustment for individual sites did not affect these results.
Studies Measuring Outcome	Study 2, Study 5
Study Designs	Experimental
Quality of Research Rating	3.9 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	26-55 (Adult)	55.8% Female 44.2% Male	64.2% Black or African American 23.3% White 10% Hispanic or Latino 2.5% Race/ethnicity unspecified
Study 2	26-55 (Adult)	72.7% Female 27.3% Male	45.5% Hispanic or Latino 35.1% Black or African American 19.5% White
Study 3	26-55 (Adult)	54.2% Female 45.8% Male	59.2% Black or African American 26.8% White 12.7% Hispanic or Latino 1.4% Race/ethnicity unspecified
Study 4	26-55 (Adult)	50.1% Male 49.9% Female	52.4% Black or African American 34.6% White 11.2% Hispanic or Latino 1.8% Race/ethnicity unspecified
Study 5	26-55 (Adult)	55.4% Female 44.6% Male	42.2% White 35.9% Black or African American 12.5% Hispanic or Latino 9.4% Race/ethnicity unspecified
Study 6	26-55 (Adult)	55.9% Male 44.1% Female	50.5% Black or African American 26% White 16.5% Hispanic or Latino 7% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

1. Reliability of measures	4. Missing data and attrition
2. Validity of measures	5. Potential confounding variables
3. Intervention fidelity	6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Drug use during treatment	4.0	3.5	3.5	4.0	4.0	4.0	3.8
2: Drug use after treatment	4.0	3.5	3.5	3.8	4.0	4.0	3.8
3: Drug problem severity during and after treatment	3.5	3.5	3.5	3.8	4.0	4.0	3.7
4: Quality of life	3.0	3.0	3.5	4.0	4.0	4.0	3.6
5: Treatment retention	4.0	3.9	3.5	3.9	4.0	4.0	3.9
6: Group/counseling attendance	4.0	4.0	3.5	4.0	4.0	4.0	3.9

Study Strengths

The drug use measures used across the studies are highly reliable and widely used in the substance abuse treatment outcomes field. The self-report measures are well regarded in the field and are widely used. Treatment retention is a very commonly used metric of treatment engagement and has strong psychometric properties as a measure. The studies were consistent in maintaining fidelity to the protocol and in the sound application of psychometrics and instrumentation to target drug use and contingency management. State-of-the-science methods were used to handle missing data and subject attrition, and potential confounding factors were addressed with appropriate random assignment. The data were analyzed using a strong modeling approach and state-of-the-science methods.

Study Weaknesses

There are some limitations of self-reported drug use, despite its being standard practice in the field. For some of the outcomes, there is no mention in the articles of how treatment fidelity was measured or if such measures had any relationship to treatment response and treatment outcome.

Readiness for Dissemination

Review Date: August 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Contingency Management [PowerPoint slides]

Petry, N. (2001, August). A clinician's guide for implementing contingency management programs: A guideline developed for the Behavioral Health Recovery Management project. Retrieved August 2007 from the Behavioral Health Recovery Management Web site: http://www.bhrm.org/guidelines/petry.pdf

Petry, N. (2004). Recent advances in the dissemination of contingency management techniques: Clinical and research perspectives. Directions in Rehabilitation Counseling, 15(11), 133-150.

Petry, N., & Stitzer, M. (2002). Contingency management: Using motivational incentives to improve drug abuse treatment (Yale University Psychotherapy Development Center Training Series No. 6). West Haven, CT: Yale University Psychotherapy Development Center.

Promoting Awareness of Motivational Incentives (PAMI) Web site, http://nattc.org/pami/pami_home.html

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.5	2.8	2.5	2.9

Dissemination Strengths

The implementation materials present a clear rationale for the use of this program. The manual is easy to follow and includes tips for clinicians on managing difficult situations. Some Web-based, self-directed materials are provided that could support the training of clinicians. A knowledge test and a clinician adherence scale are available to support quality assurance.

Dissemination Weaknesses

Some program materials are redundant. The manual refers to clinician training that includes a didactic seminar and role-plays, but it is unclear who directs this training. While clinician supervision is strongly recommended to enhance quality assurance, no supervisor training or support is provided. There are no clear suggestions for how one might evaluate program impact in a clinical rather than research setting.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Intervention manual	Free	Yes
Contingency management manual and video	$59 per set	Yes
In-person training	Free	No
Implementation support	Free	No
Contingency Management Competence Scale	Free	Yes

Additional Information

Costs include $80-$240 per patient in prizes, plus the salary of up to one staff person responsible for purchasing prizes and conducting urinalysis and breath-analysis testing. Prizes may total $240-$400 over a 3-month period, but patients typically earn half this much during this period, depending on the reinforcement schedule. The cost-effectiveness of the intervention has been documented in two published articles.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Peirce, J. M., Petry, N. M., Stitzer, M. L., Blaine, J., Kellogg, S., Satterfield, S., et al. (2006). Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment. A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry, 63(2), 201-208.

* Petry, N. M., Alessi, S. M., Marx, J., Austin, M., & Tardif, M. (2005). Vouchers versus prizes: Contingency management treatment of substance abusers in community settings. Journal of Consulting and Clinical Psychology, 73(6), 1005-1014.

Petry, N. M., & Martin, B. (2002). Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients. Journal of Consulting and Clinical Psychology, 70(2), 398-405.

* Petry, N. M., Martin, B., & Simcic, F., Jr. (2005). Prize reinforcement contingency management for cocaine dependence: Integration with group therapy in a methadone clinic. Journal of Consulting and Clinical Psychology, 73(2), 354-359.

* Petry, N. M., Peirce, J. M., Stitzer, M. L., Blaine, J., Roll, J. M., Cohen, A., et al. (2005). Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs. A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry, 62(10), 1148-1156.

* Petry, N. M., Tedford, J., Austin, M., Nich, C., Carroll, K. M., & Rounsaville, B. J. (2004). Prize reinforcement contingency management for treating cocaine users: How low can we go, and with whom? Addiction, 99(3), 349-360.

Contact Information

To learn more about implementation or research, contact:
Nancy M. Petry, Ph.D.
(860) 679-2593
npetry@uchc.edu

Maxine L. Stitzer, Ph.D.
(410) 550-5044
mstitzer@jhmi.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.