NIDA-CTN-0007
(Enrollment Closed)
Motivational Incentives for Enhanced Drug Abuse
Recovery: Methadone Clinics
STUDY OBJECTIVES:
The purpose of the proposed research is to implement and systematically
evaluate, in community treatment settings, motivational incentive
procedures that have been well researched and have proven efficacious
in a variety of treatment research clinics. The study will determine
if motivational incentives along with standard care therapy is more
effective than standard therapy alone for the treatment of patients
using cocaine or methamphetamine and entering a substance abuse
treatment program.
STUDY POPULATION/ELIGIBILITY CRITERIA:
The study population will be drawn from patients entering methadone
maintenance treatment and remaining in treatment for at least one
month. Primary eligibility criteria for study entry is evidence
of stimulant use (cocaine or methamphetamine) as determined by urinalysis
test results. Eligible patients must submit at least one cocaine
or methamphetamine positive urine within the two weeks prior to
study entry.
STUDY DESIGN:
The study utilizes a two group random assignment design. Thus,
interested and eligible participant volunteers will be assigned
to receive usual care or usual care supplemented by a motivational
incentive program. The study lasts for 12 weeks, with follow-up
interviews scheduled at 1, 3 and 6 months after study enrollment.
USUAL CARE TREATMENT:
Those assigned to usual care will receive standard counseling procedures
used at the CTP for 12 weeks. Participants assigned to the usual
care condition will be expected to meet with the RA twice weekly
to give urine samples and to participate in follow-up interviews,
as scheduled.
INCENTIVE PROCEDURES:
In addition to usual care services, those subjects in the motivational
incentive group will be given the opportunity to receive tangible
incentives twice weekly based on drug-free urine test results. Each
time a participant tests negative for the primary target drugs cocaine,
methamphetamine, amphetamines, and alcohol (via breathalyzer), they
will be able to make recovery picks from the abstinence bowl. Some
picks will result in no incentive award. Some picks will result
in receipt of a "small" incentive such as a soda, candy bar or toiletry
item. Yet other picks may result in receipt of a larger incentive
such as a radio, walkman or gift certificate to a local restaurant,
grocery or retail store. Clients and clinic staff will determine
the specific incentives to be awarded within monetary guidelines
specified in the protocol. The number of recovery picks escalates
with consecutive weeks in which urine tests are negative for all
4 primary target substances. Bonus picks are also available at each
incentive opportunity for urines that test negative for opiates.
The maximum cash value of tangible incentives awarded to participants
who remain continuously abstinent from all tested drugs will be
approximately $400 per subject.
EFFICACY ASSESSMENTS:
Treatment retention of study subjects will be tracked and mean
retention duration compared for the two study groups. Regular urine
testing conducted during treatment will also be used to compare
performance of incentive and control participants, as will data
on counseling utilization. Primary source of data for establishing
efficacy will be obtained from follow-up interviews and urine testing
obtained from all subjects who sign informed consent, whether or
not they stay in treatment for 12 weeks ("intent-to-treat" sample).
Subjects will be assessed at all follow-up visits (1, 3, and 6 months)
for: 1) drug use via full screen urinalysis and alcohol breathalyzer,
2) drug use via self-report, 3) HIV risk exposure, 4) employment
status, 5) criminal activity, 6) gambling behavior, and 7) psychiatric
symptoms. It is predicted that outcomes for those assigned to receive
incentives in addition to standard care will be better than outcomes
for those who receive standard care only. Specifically, those who
receive incentives will have less drug use and criminal activity,
more employment and fewer psychiatric symptoms.
SUBJECT BENEFITS:
All study participants will receive compensation of $25 for each
follow-up assessment completed. All participants may benefit from
stopping their drug use during treatment and working toward life-style
changes that are needed to sustain long-term abstinence. Those in
the incentive condition may experience enhanced motivation to abstain
and may benefit from the tangible incentives received.
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