Clinical Guidance: Contingency Management of Stimulant Use in Seriously Mentally Ill Patients
Awarding a chance to receive a prize in return for each stimulant-free urine sample reduces stimulant use in outpatients with serious mental illness and stimulant dependence. In a 3-month study of 176 patients with amphetamine, methamphetamine, or cocaine dependence, McDonell et al. (CME, p. 94) calculated the cost of urine testing and reinforcers to be $864 for each participant abstinent for 8 or more weeks, but the patients had only 14 total days of hospitalization, compared to 152 days for patients in a control condition. Stimulant abstinence is associated with improvements in additional outcomes, such as alcohol use, use of injected drugs, and psychiatric symptoms. Abstinence may persist for several months after the intervention ends. Editorialist Weiss (p. 6) applauds the integration of addiction treatment and psychiatry and emphasizes the potential financial advantage for payers, such as the Veterans Health Administration, which recently approved contingency management for drug dependence.