Rewarding early abstinence in Veterans Health Administration addiction clinics

Area of Science:

• Clinical Psychology
• Addiction Medicine
• Behavioral Health

Background:

• Substance use disorders pose significant challenges within the Veteran population.
• Contingency management (CM) is a behavioral intervention that uses incentives to reinforce treatment adherence and abstinence.
• Evaluating CM's effectiveness in real-world clinical settings, like the Veterans Health Administration (VHA), is crucial.

Purpose of the Study:

• To assess the impact of adding a CM intervention to usual care for Veterans with alcohol or stimulant dependence.
• To compare during-treatment and post-treatment outcomes between CM and usual care groups.
• To determine if CM effectiveness differs between alcohol and stimulant use disorders.

Main Methods:

• A randomized controlled trial involving 330 Veterans diagnosed with alcohol dependence (n=191) or stimulant dependence (n=139).
• Participants were assigned to 8 weeks of either usual care or usual care plus CM.
• Follow-up assessments were conducted at 2, 6, and 12 months post-treatment.

Main Results:

• In the alcohol-dependent subgroup, CM significantly increased negative urine samples, treatment retention, and duration of abstinence compared to usual care.
• CM participants with alcohol dependence also submitted more negative samples during follow-ups.
• No significant intervention effects were observed for the stimulant-dependent subgroup.

Conclusions:

• Contingency management is an effective intervention for improving treatment outcomes in Veterans with alcohol dependence.
• The findings support the integration of CM into VHA substance use disorder treatment protocols for alcohol use disorders.
• Further research may be needed to explore CM's efficacy for stimulant use disorders in Veterans.