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Contingency Management: What Patients Really Want

January 1, 2016
Hartzler, B., Garrett, SB.
Hartzler B, Garrett SB. Interest and Preferences for Contingency Management Design Among Addiction Treatment Clientele. American Journal of Drug and Alcohol Abuse 2015 (in press).
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  • This new article from the Pacific Northwest Node of the CTN dispels some of the commonly-held beliefs about what patients really want as incentives when participating in contingency management (CM) programs.
  • Currently promoted CM methods are empirically validated, but little is known about whether or not they’re actually congruent with the real interests and preferences of addiction treatment clients in the U.S.
  • This study of clients in 3 community treatment programs in the CTN aimed to ask the question: What do clients really want?

Using anonymous surveys of over 350 enrollees, the survey documented interest in incentives and preferences for:

  • Fixed-ratio vs. variable-ratio: i.e., would you rather earn $5 a week for 10 weeks, or participate in a weekly drawing in which you could earn as much as $50 each week?
  • Immediate vs. delayed distribution of earned incentives: would you rather earn $5 per week for 10 weeks, or save weekly points for 10 weeks to earn $50 at the end?
    Analyses ruled out site differences in survey responses, and then tested age and gender as influences.

Results found:

  • Interest in different types of $50 vouchers (e.g., retail, transportation, cash), was roughly the same, with a mean sample rating of 3.49 on a 5-point scale, where 1 was “would not like at all” and 5 was “would really like;
  • No influence of gender on client interest in incentives, but age was an inverse predictor, with youth being more interested than older clients;
  • A majority of clients preferred fixed-ratio incentives and delayed distribution, contrary to the design of many CM programs

Conclusions: This study offered a helpful glimpse into client perspectives about design features of CM interventions. Future efforts to disseminate CM may be more successful if flexibly undertaken in a manner that incorporates the interests and preferences of local client groups.

Find it in the CTN Dissemination Library: