Evidence Ratings for Outcomes:
Drugs Substance Abuse – Multiple substances
Practice Goals/Target Population
Contingency government interventions for piece use disorders are used in diagnosis and impediment programs and are designed to inspire certain function among module participants, with a altogether idea of avoidance from piece use. Contingency government interventions prerogative module participants when they vaunt certain behaviors (e.g., disastrous drug tests). However, when module participants vaunt disastrous behaviors (e.g., certain drug tests), rewards are withheld, or participants accept punitive consequences.
Contingency government interventions are formed on operant conditioning. Operant conditioning is a training routine that aims to control and/or figure function by certain or disastrous consequences, typically famous as rewards or punishments, respectively (Higgins and Petry 1999; Skinner 1938).
In strait government programs, a active diagnosis part is incentives/rewards; participants are incentivized to vaunt certain function since doing so will outcome in a reward. Although there are opposite forms of strait government programs for piece use disorders, a use of incentives/rewards is common opposite all module types. Two of a many common strait government programs for piece use disorders embody Voucher-based Reinforcement Therapy (VBRT) and Variable Magnitude of Reinforcement Procedure, also famous as a Fishbowl Procedure (Prendergast et al. 2006; Dutra et al. 2008).
In VBRT, when module participants contention samples that shade disastrous for drug use, they accept vouchers that have several financial values. These vouchers can be traded in for goods/services. However, when samples prove new drug use, these vouchers are withheld. There are several bolster schedules that coincide with VBRT; for example, vouchers can boost with any unbroken disastrous drug sample, vouchers can reset to a reduce value following a certain drug sample, or a prerogative document can be supposing after a certain series of disastrous drug samples (Prendergast et al. 2006).
In Variable Magnitude of Reinforcement Procedure, also famous as a Fishbowl Procedure, participants can pull from a play that contains slips of paper, after providing a disastrous drug sample. Approximately half of a slips contend “good job,” while a other half prove a financial reward, trimming from $1 to $100. Thus, with any draw, participants have a possibility of winning a prize. After providing a certain series of unbroken disastrous drug samples, participants accept prerogative draws from a bowl. As with other strait government programs, if participants contention a certain drug sample, they are incompetent to pull from a play (Prendergast et al. 2006).
Although not as common, there are other variations of strait government programs for piece use disorders. One module offers people a ability to take home doses of methadone after providing a certain series of disastrous drug samples. Other programs offer people affordable housing and work opportunities fortuitous on a receipt of disastrous drug samples and vital a drug-free lifestyle.
Drugs Substance Abuse – Multiple substances
Overall, a formula from dual meta-analyses indicated that strait government programs had a statistically poignant impact on piece use disorders. Aggregating a formula from 43 randomized tranquil trials (RCTs), Prendergast and colleagues (2006) found a statistically poignant altogether meant outcome distance of 0.44, suggesting that participants in strait government programs had reduce rates of unlawful drug use, ethanol use, and tobacco use than those who did not attend in such programs. Similarly, Dutra and colleagues (2008) many-sided a outcome sizes from 14 studies (RCTs and quasi-experimental studies) and found a statistically poignant meant outcome distance of 0.58, suggesting that participants in strait government programs had reduce rates of unlawful drug use than participants in a control conditions.
Prendergast and colleagues (2006) evaluated a efficiency of strait government programs for substance-using individuals. To be authorised for inclusion in a meta-analysis, studies had to be outcome evaluations of strait government programs, delivered to adults or juveniles, and designed to provide coherence on alcohol, tobacco, or unlawful drugs. Moreover, studies had to be published in English between 1970 and 2002, have used possibly an initial pattern or quasi-experimental design, and have a sum representation distance of during slightest 10. Finally, usually studies that enclosed adequate information to discriminate an outcome distance were authorised for inclusion. To brand studies, a extensive hunt was conducted of a accumulation of bibliographic databases regulating hunt terms that interconnected a sold technique (e.g., strait management, token economy, behavioral contracting) with terms referring to a specific problem function (e.g., addiction, drug abuse, alcoholism, cocaine, tobacco).
A sum of 1,150 studies were identified by this hunt strategy. After screening these studies opposite a eligibility criteria, a sum of 81 studies were authorised for inclusion in a meta-analysis. However, of these 81 studies, usually 47 were used in a final research given a singular series of information supposing in some of a studies. All 47 studies were conducted in a United States, with 43 regulating initial designs, and 4 regulating quasi-experimental designs. Approximately 70 percent of a enclosed studies were conducted during a 1990s. Moreover, opposite a 47 studies, representation sizes ranged from 12 to 844, with a median representation distance of 69. Finally, nonetheless attempts were done to locate unpublished literature, a enclosed studies were all published studies. The aim drugs of a enclosed studies were marijuana, tobacco, cocaine, opiates, alcohol, and a multiple of one or some-more drugs. Treatment approaches enclosed cash, methadone take-homes, methadone dose increase, methadone dose decrease, graduation to subsequent diagnosis phase, module discharge, vouchers, price reduction, and rebate in hospital responsibilities.
To establish either strait government programs for piece use disorders are effective, both bound effects and pointless effects models were used in a analysis; however, a categorical outcome of seductiveness (illicit drug use, ethanol use, and tobacco use) was found regulating a pointless effects model.
Using meta-analytic techniques, Dutra and colleagues (2008) analyzed a outcome of strait government programs on unlawful piece use disorders, including cocaine, opiates, cannabis, and polysubstance abuse and dependence. To brand studies, PsycINFO was used to find articles published between 1840 and Mar 2005, regulating a accumulation of pivotal hunt terms, including though not singular to cocaine, piece use, piece abuse, diagnosis outcome, contingency, and voucher. Additionally, MEDLINE was used to brand articles accessible between 1966 and Mar 2005, and Cochrane Central Register of Controlled Trials was used to brand studies for a initial entertain of 2005. Both PsychINFO and MEDLINE searches were singular to those published in English.
To be authorised for inclusion in a meta-analysis, studies had to be investigations of a efficiency of particular psychosocial treatments for piece abuse/dependence (not including ethanol or nicotine abuse/dependence), and use randomized tranquil trials, including a comparison group. Moreover, studies were singular to adult participants and to investigations on a efficiency of nonintensive outpatient treatments. Nonintensive outpatient diagnosis was tangible as a limit of three, 2-hour per week diagnosis sessions. Finally, studies had to embody self-report outcomes of seductiveness or toxicology screening outcomes of interest. Self-report outcomes of seductiveness enclosed 1) meant limit series of days or weeks temperate via treatment, 2) meant percent of days temperate via treatment, 3) percent of representation temperate for 3 or some-more weeks via treatment, 4) percent of representation demonstrating posttreatment/clinically poignant abstinence, and 5) posttreatment scores on a Addiction Severity Index. Toxicology outcomes of seductiveness enclosed 1) meant series of disastrous drug screens via treatment, 2) meant percent of disastrous drug screens via treatment, and 3) percent of representation that demonstrated clinically poignant abstinence.
Using this authorised criterion, a sum of 34 studies were authorised for inclusion in a meta-analysis. Across a 34 studies, participants were approximately 35 years aged and, on average, 62.2 percent masculine and 61.0 percent white (information about other races/ethnicities was not provided). However, of these 34 studies, 14 pertained to strait management/voucher programs; a other 20 studies looked during other forms of diagnosis that were not reviewed for CrimeSolutions.gov. Across a 14 studies, a intent-to-treat representation (i.e., a representation distance of a diagnosis condition) enclosed 785 participants (this did not embody a representation distance of participants in a control condition, that was not provided). In a 14 studies, a diagnosis condition perceived strait management, while a control condition perceived diagnosis as usual, motivational encouragement interviewing, 12-step facilitation, noncontingency management, or customary care.
Overall, to establish a impact of strait government on unlawful piece use disorders, an normal meant outcome distance was combined regulating Cohen’s d.
Evidence-Base (Meta-Analyses Reviewed)
These sources were used in a growth of a use profile:
Prendergast, Michael, Deborah Podus, John Finney, Lisa Greenwell, and John Roll. 2006. “Contingency Management for Treatment of Substance Use Disorders: A Meta-Analysis.” Addiction 101(11):1546–60.
Dutra, Lisa, Georgia Stathopoulou, Shawnee L. Basden, Teresa M. Leyro, Mark B. Powers, and Michael W. Otto. 2008. “A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorders.” American Journal of Psychiatry 165(2):179–87.
These sources were used in a growth of a use profile:
Higgins, S.T., and N.M. Petry. 1999. “Contingency Management: Incentives for Sobriety.” Alcohol Research Health 23(2):122–27.
Skinner, B. F. 1938. The Behavior of Organisms: An Experimental Analysis. New York, NY: Appleton-Century-Crofts.
Following are CrimeSolutions.gov-rated programs that are associated to this practice:
Prize-Based Incentive Contingency Management for Substance Abusers
A chronicle of strait government that provides adult piece abusers in community-based diagnosis with an event to win prizes if they sojourn drug free. The module is rated Effective. The inducement organisation had a longest drug use abstinence, investigate retention, and attended some-more conversing sessions compared with those who perceived common care.