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Implementation of Client Incentives within a Recovery Navigation Program.

Mary Brolin1, Maria Torres2, Dominic Hodgkin1

  • 1Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453.

Journal of Substance Abuse Treatment
|September 30, 2016
PubMed
Summary
This summary is machine-generated.

Recovery support navigators (RSN) and incentives increased service access for substance use disorder clients. However, both RSN-only and RSN with incentives groups showed similar healthcare cost increases post-detoxification.

Keywords:
Client incentivesContingency managementNavigatorsSubstance abuse

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Area of Science:

  • Health Services Research
  • Addiction Medicine
  • Behavioral Economics

Background:

  • Repeated detoxification admissions for substance use disorders (SUD) incur significant healthcare costs.
  • Recovery Support Navigator (RSN) services aim to improve outcomes for SUD clients.
  • Contingency management interventions, using incentives, are explored to enhance engagement in recovery services.

Purpose of the Study:

  • To evaluate the impact of Recovery Support Navigator (RSN) services, with and without contingent incentives, on behavioral and cost outcomes for individuals with substance use disorders.
  • To compare service utilization rates between RSN-only and RSN plus incentive (RSN+I) groups.
  • To analyze changes in healthcare costs over 12 months post-detoxification for both intervention groups.

Main Methods:

  • A group-level cross-over design was employed across four detoxification programs.
  • New intakes were assigned to either RSN-only or RSN+I services, with intervention roles reversed mid-study.
  • The RSN+I group could earn up to $240 in gift cards for achieving 12 predefined recovery-related behaviors.

Main Results:

  • The RSN+I group demonstrated significantly higher access to RSN services (35.5%) compared to the RSN-only group (22.3%).
  • Among RSN+I clients, 51% did not earn any incentives, while 19% earned one, 12% earned two, and 18% earned three or more.
  • Adjusted average monthly healthcare costs increased at similar rates for both RSN-only and RSN+I groups over the 12-month follow-up period.

Conclusions:

  • While incentives increased RSN service engagement, they did not significantly alter long-term healthcare cost trajectories.
  • Limited incentive uptake suggests potential issues with program design, communication, organizational factors, or navigator bias.
  • Findings offer valuable insights for designing and implementing future multi-target contingency management interventions in real-world addiction treatment settings.