Substance Use Disorders
Conditions
Keywords
Psychiatric adherence, Voucher incentives, Methadone treatment
Brief summary
The purpose of the study is to evaluate methods to help people in substance abuse treatment receive better psychiatric care. Patients enrolled in the study will be offered three months of standard psychiatric treatment, which consists of weekly individual counseling and group counseling, as well as regular appointments with a psychiatrist. Patients will be randomly assigned to standard psychiatric care or standard psychiatric care plus voucher incentives. These incentives can be earned by successfully attending all scheduled psychiatric appointments each week. The investigators expect that patients in the voucher condition will attend more psychiatric sessions, which will lead to greater reductions in psychiatric distress.
Detailed description
Male and female opioid-dependent patients at Addiction Treatment Services with any current psychiatric disorder (N = 100) will be randomly assigned to one of two psychiatric service conditions: 1) reinforced on-site integrated care (ROIC), with voucher incentives contingent on attending weekly psychiatric sessions; or 2) standard on-site integrated care (SOIC). Participants in both conditions will receive access to the same schedule and range of psychiatric and substance abuse treatment services. Participants will be assessed for 3-months post-randomization to determine rates of service utilization and adherence to psychiatric care, changes in scope and severity of psychiatric and psychosocial problems, and rates of drug use and treatment retention. Positive findings would have considerable heuristic and health care policy and practice implications. The entire study, including dissemination of the major findings at a national meeting and submission of the first manuscript, is designed to be completed within 2-years.
Interventions
BEHAVIORALVoucher Reinforcement
Patients in this condition will be able to earn a voucher for each week that they have attended all scheduled psychiatric sessions. These sessions may include individual therapy appointments, group therapy appointments, or psychiatrist appointments. Each voucher will be worth $25, and can be exchanged for goods and services that will be purchased by a research assistant. The maximum amount of voucher earnings over the study is $300.
BEHAVIORALStandard Control
Patients assigned to this condition will be treated at ATS for psychological problems. They will be scheduled to participate in individual therapy sessions with a psychiatrist and with their substance abuse counselor. They will also be referred to attend group therapy one time per week. No voucher incentive will be offered in this condition.
Sponsors
National Institute on Drug Abuse (NIDA)
Johns Hopkins University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* At least 18 years of age * Voluntarily seeking psychiatric treatment * Meets DSM-IV criteria for opiate dependence * Meets FDA/CSAT guidelines for methadone maintenance * Meets DSM-IV criteria for at least one current psychiatric disorder
Exclusion criteria
* Pregnancy * Onset or acute exacerbation of a medical illness requiring immediate and intense care * An organic mental disorder (e.g., delirium, dementia) * Current participation in psychiatric care * Mandatory psychiatric treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Psychiatric Treatment Adherence | Weekly for 12 weeks | Patient adherence to all scheduled psychiatric sessions (i.e. individual, group, psychiatrist) will be measured weekly for 12 weeks. |
| Level of Psychiatric Distress | Every 4-weeks for 12 weeks | Patients will complete the Addiction Severity Index (ASI) and the SCL-90 every 4-weeks, for 12-weeks, to measure their current levels of psychiatric distress. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Psychiatric Medication Adherence | Every 4-weeks | Patients will complete a Medication-Taking Scale every 4-weeks to assess their adherence to prescribed psychiatric medications. |
| Substance Use | Weekly for 12-weeks | Patients are required to leave weekly urine specimens (for 12-weeks) which are tested for drugs of abuse (opioids, cocaine, benzodiazepines). |
| Treatment Retention | Weekly for 12-weeks | The length of time subjects remain in treatment is tracked throughout the study. |
Countries
United States
Outcome results
None listed