Tamar Krishnamurti1, Kimberly Ling Murtaugh2, Lara Van Nunen3, Alexander L Davis4, Jonathan Ipser3, Steven Shoptaw5. 1. Division of General Internal Medicine, University of Pittsburgh, Meyran Avenue, Suite 200, Pittsburgh, PA 15213, USA. Electronic address: tamark@pitt.edu. 2. Department of Public Policy, Luskin School of Public Affairs, University of California at Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. 3. Department of Psychiatry and Mental Health, University of Cape Town, South Africa. 4. Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA. 5. Department of Public Policy, Luskin School of Public Affairs, University of California at Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
Abstract
AIMS: Methamphetamine Use Disorder is prevalent in South Africa. This analysis uses data from a contingency management (CM) pilot study in South Africa to replicate and expand on a U.S.-based study showing that CM voucher spending was associated with drug abstinence behavior. DESIGN: Participants with methamphetamine-use disorder were enrolled in an 8-week CM trial requiring thrice weekly visits and received cash vouchers in exchange for stimulant-negative urines at each visit. PARTICIPANTS: Participants were 33 treatment-seeking individuals with methamphetamine use disorder including 22 men (66.7%) and 11 women (33.3%) with a mean age of 34 years (S.D. = 7.7). Participants reported using methamphetamine for a mean of 11.7 years (S.D. = 4.9). SETTING: All study procedures took place in South Africa between August 2016 and May 2018. MEASUREMENTS: A time-lagged counting process Cox Proportional Hazards model for recurrent event survival analysis examined the relationship between frequency of and participant-categorized type of CM expenditures (hedonic, utilitarian, consumable or durable) and drug abstinence. FINDINGS: After controlling for severity of baseline methamphetamine use and accumulated CM earnings (proxied by cumulative negative urines), those spending CM earnings at a previous visit ("spenders") were more likely to produce stimulant-negative urine samples subsequently, compared to those who did not ("savers") [OR = 1.23, CI = 1.08-1.53, p = .002]. There were significantly more cumulative stimulant-negative results among spenders vs. savers, p < .001, although cumulative spending did not significantly predict abstinence once spending in the prior time period was controlled for, suggesting a recency effect tied to the underlying spending mechanism. When extending the original analyses to look at the effect of spending on current abstinence, controlling only for recent abstinence (rather than cumulative abstinence), spending was no longer a significant predictor. Spending type did not affect methamphetamine abstinence. Qualitative results suggest spending CM vouchers may support social reintegration over the course of the trial. CONCLUSIONS: Abstinence outcomes are a function of CM spending in both the U.S. and South Africa. Findings of a significant relationship between contingency management spending and subsequent stimulant-negative urine samples across geographic locations provide guidance toward future work in optimizing CM efficacy.
AIMS: Methamphetamine Use Disorder is prevalent in South Africa. This analysis uses data from a contingency management (CM) pilot study in South Africa to replicate and expand on a U.S.-based study showing that CM voucher spending was associated with drug abstinence behavior. DESIGN:Participants with methamphetamine-use disorder were enrolled in an 8-week CM trial requiring thrice weekly visits and received cash vouchers in exchange for stimulant-negative urines at each visit. PARTICIPANTS: Participants were 33 treatment-seeking individuals with methamphetamine use disorder including 22 men (66.7%) and 11 women (33.3%) with a mean age of 34 years (S.D. = 7.7). Participants reported using methamphetamine for a mean of 11.7 years (S.D. = 4.9). SETTING: All study procedures took place in South Africa between August 2016 and May 2018. MEASUREMENTS: A time-lagged counting process Cox Proportional Hazards model for recurrent event survival analysis examined the relationship between frequency of and participant-categorized type of CM expenditures (hedonic, utilitarian, consumable or durable) and drug abstinence. FINDINGS: After controlling for severity of baseline methamphetamine use and accumulated CM earnings (proxied by cumulative negative urines), those spending CM earnings at a previous visit ("spenders") were more likely to produce stimulant-negative urine samples subsequently, compared to those who did not ("savers") [OR = 1.23, CI = 1.08-1.53, p = .002]. There were significantly more cumulative stimulant-negative results among spenders vs. savers, p < .001, although cumulative spending did not significantly predict abstinence once spending in the prior time period was controlled for, suggesting a recency effect tied to the underlying spending mechanism. When extending the original analyses to look at the effect of spending on current abstinence, controlling only for recent abstinence (rather than cumulative abstinence), spending was no longer a significant predictor. Spending type did not affect methamphetamine abstinence. Qualitative results suggest spending CM vouchers may support social reintegration over the course of the trial. CONCLUSIONS: Abstinence outcomes are a function of CM spending in both the U.S. and South Africa. Findings of a significant relationship between contingency management spending and subsequent stimulant-negative urine samples across geographic locations provide guidance toward future work in optimizing CM efficacy.
Authors: Hetta Gouse; John A Joska; Ryan R Lion; Melissa H Watt; Warren Burnhams; Adam W Carrico; Christina S Meade Journal: Drug Alcohol Rev Date: 2015-12-14