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Drug Alcohol Depend. 2018 Apr 1;185:367-373. doi: 10.1016/j.drugalcdep.2017.12.020. Epub 2018 Feb 16.

The national implementation of Contingency Management (CM) in the Department of Veterans Affairs: Attendance at CM sessions and substance use outcomes.

Author information

1
Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States. Electronic address: dominick.dephilippis@va.gov.
2
Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT, 06030, United States.
3
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States.
4
Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, 10003, United States.
5
Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States.

Abstract

BACKGROUND:

In 2011, the Department of Veterans Affairs launched an initiative to expand patients' access to contingency management (CM) for the treatment of substance use disorders, particularly stimulant use disorder. This study evaluates the uptake and effectiveness of the VA initiative by presenting data on participation in coaching, fidelity to key components of the CM protocol, and clinical outcomes (CM attendance and substance use).

METHODS:

Fifty-five months after the first VA stations began offering CM to patients in June 2011, 94 stations had made CM available to 2060 patients. As those 94 VA stations began delivering CM to Veterans, their staff participated in coaching calls to maintain fidelity to CM procedures. As a part of the CM coaching process, those 94 implementation sites provided data describing the setting and structure of their CM programs as well as their fidelity practices. Additional data on patients' CM attendance and urine test results also were collected from the 94 implementation sites.

RESULTS:

The mean number of coaching calls the 94 programs participated in was 6.5. The majority of sites implemented CM according to recommended standard guidelines and reported high fidelity with most CM practices. On average, patients attended more than half their scheduled CM sessions, and the average percent of samples that tested negative for the target substance was 91.1%.

CONCLUSION:

The VA's CM implementation initiative has resulted in widespread uptake of CM and produced attendance and substance use outcomes comparable to those found in controlled clinical trials.

KEYWORDS:

Contingency management; Department of Veterans Affairs; Stimulants

PMID:
29524874
PMCID:
PMC6435332
DOI:
10.1016/j.drugalcdep.2017.12.020
[Indexed for MEDLINE]
Free PMC Article

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