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

• Published in: Drug and alcohol dependence 2018-04, Vol.185, p.367-373
• Main Authors: DePhilippis, Dominick, Petry, Nancy M., Bonn-Miller, Marcel O., Rosenbach, Sarah B., McKay, James R.
• Format: Article
• Language: English
• Subjects: Adult; Attendance; Behavior Therapy - trends; Central Nervous System Stimulants - adverse effects; Clinical outcomes; Clinical research; Clinical trials; Coaching; Contingency; Contingency learning; Contingency management; Contingency planning; Delivery scheduling; Department of Veterans Affairs; Effectiveness; Female; Fidelity; Government agencies; Humans; Initiatives; Male; Medical research; Medical treatment; Patient Compliance - psychology; Patients; Stations; Stimulants; Substance abuse treatment; Substance use; Substance use disorder; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Substance-Related Disorders - therapy; United States - epidemiology; United States Department of Veterans Affairs - trends; Uptake; Urine; Urine tests; Veterans; Veterans - psychology
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2017.12.020

•From June 2011 to December 2015, the Department of Veterans Affairs (VA) provided Contingency Management (CM) to 2060 patients in 94 programs.•Patients attended 55.9% of the 49,104 available CM sessions.•91.9% of the 27,850 urine samples tested negative for the target substance.•These clinical outcomes are comparable to those seen in published CM studies. 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). 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. 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%. 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.