Motivational incentives research in the National Drug Abuse Treatment Clinical Trials Network

Abstract

The purpose of this article is to review both main findings and secondary analyses from studies of abstinence incentives conducted in the National Drug Abuse Treatment Clinical Trials Network (CTN). Previous research has supported the efficacy of tangible incentives provided contingent on evidence of recent drug abstinence. CTN conducted the first multisite effectiveness trial of this novel intervention. Study participants were stimulant abusers (N = 803) participating in treatment at 14 clinical sites and randomly assigned to treatment as usual with or without a prize draw incentive program. Study participants could earn up to $400 over 3 months for submission of drug-free urine and breath (BAL) specimens. Three-month retention was significantly improved by incentives offered to psychosocial counseling clients (50% incentive vs. 35% control retained), whereas ongoing stimulant drug use was significantly reduced in methadone maintenance clients (54.4% incentive vs. 38.7% control samples testing stimulant-negative). In both settings, duration of continuous abstinence achieved was improved in the incentive condition. These studies support effectiveness of one abstinence incentive intervention and highlight the different outcomes that can be expected with application in methadone maintenance versus psychosocial counseling treatment settings. Secondary analyses have shown the importance of early treatment positive versus negative urine screens in moderating the outcome of abstinence incentives and have explored both safety and cost-effectiveness of the intervention. Implications for the use of motivational incentive methods in clinical practice are discussed.

Figure 1

Percent of submitted samples testing negative for stimulants and alcohol. Data are shown for stimulant abusers enrolled in methadone maintenance treatment and randomly assigned to receive usual care with (n = 198) or without (n = 190) a prize draw abstinence incentive intervention. The intervention was implemented over a 12-week period with two study visits scheduled per week. from Peirce et al., 2006.

Figure 2

Percent of participants retained. Data are shown for stimulant abusers enrolled in psychosocial counseling treatment and randomly assigned to receive usual care treatment with (n = 209) or without (n = 206) a prize-based abstinence incentive intervention. The intervention was implemented over a 12-week period with two study visits scheduled per week. adapted from Petry et al., 2005

Figure. 3

Percent of stimulant and alcohol negative samples submitted at each of 24 study visits during a 12-week intervention with missing samples coded as positive. Data is shown separately for methadone maintained participants who tested stimulant negative (left-hand panel; N = 94) versus stimulant positive (right-hand panel; N = 292) at study intake. Data in each panel is shown separately for participants exposed to usual care with (closed symbols) or without (open symbols) an added prize draw abstinence incentive procedure. from Stitzer, Peirce, et al., 2007.

Figure 4

Percent of stimulant and alcohol negative samples submitted at each of 24 study visits during a 12-week intervention with missing samples coded as positive. Data is shown separately for psychosocial counseling participants who tested stimulant negative (left-hand panel; N = 306) versus stimulant positive (right-hand panel; N = 108) at study intake. Data in each panel is shown separately for participants exposed to usual care with (closed symbols) or without (open symbols) an added prize draw abstinence incentive procedure. from Stitzer, Petry, et al., 2007.