Are gift cards enough to keep SCC addicts off meth long term?

The County is dipping its toes into “contingency management” techniques for substance abuse, which reward abstinence via tangible rewards (usually vouchers). But research hedges on long-term benefits of gov't cash incentives for sobriety. Two widely cited meta-analyses excerpted below.

From peer-reviewed scientific journal Preventive Medicine, a 2009–2014 meta-analysis:

Clearly there is a weakening in the magnitude of treatment effect size when comparing overall effects while incentives are in place compared to overall effects after their discontinuation, with generally moderate to large effect sizes observed during the former (i.e., 0.62 (95% CI: 0.54, 0.70) and small effect sizes in the latter (i.e., 0.26 (95% CI: 0.11, 0.41). Others have noted this trend toward more CM studies examining the sustainability of post-intervention treatment effects as well (McKay et al., 2010), but more needs to be done in terms of moving in the direction of all CM studies including followup assessments and increases in the quality of these efforts.... Note that in the small handful of studies that were explicitly focused on promoting longer-term outcomes (Table 4), average overall effect size was 0.49 (95% CI: 0.02, 0.97). Combined treatment interventions that increase during-treatment abstinence and provide skills for sustaining abstinence may extend the duration of abstinence post-treatment (McKay et al., 2010; Higgins et al., 2000), as might employment-based workplace contingencies or other comparable arrangements that are designed to keep programmed contingencies for reinforcing abstinence in place long-term or chronically (Silverman et al., 2012).

Further development of this intervention model will be enhanced by greater attention to promoting and sustaining longer-term change...

This article originally appeared in Preventive Medicine. Read the whole thing here (subscriber paywall).

From peer-reviewed scientific journal Addiction, a 2000–2013 meta-analysis:

Adding prize-based contingency management to behavioral support for substance use disorders can increase short-term abstinence, but the effect does not appear to persist to 6 months....

Short-term follow-up

The nine studies that included short-term follow-up assessments (Table 1; Fig. 3) identified two small, three medium and one large effect size; non-significant effects were identified for three of the studies. The weighted mean effect size of associated with these studies was d = 0.33 (P = 0.002; 95% CI = 0.12, .54), indicating a small-to-medium effect. The I 2 index indicated a low degree of heterogeneity (I 2 = 39.35%; CI = 0%, 72.07%).

Six-month follow-up

Four of the six 6-month outcome effect sizes showed nonsignificant effects. There was one small and one moderate effect, both in favor of the control condition; however, the test statistics associated with these effects were not significant (Table 1; Fig. 4). The weighted mean effect size for these studies was d = −0.09 (P = 0.351; 95% CI = −0.28, 0.10), indicating a non-significant effect. Again, the I 2 index suggested the presence of no heterogeneity (I 2 ≤ 0%; 95% CI = 0%, 62.9%).

The combined results for the two follow-up metaanalyses suggest a decrease in the effect size over time. In comparison to the EOT effect size (d = 0.46), the shortand 6-month follow-up effect sizes were 0.33 and −0.09, respectively. The 95% CI indicates that the long-term abstinence rate effect size was not significantly different from zero.

This article originally appeared in Addiction. Read the whole thing here (subscriber paywall).

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