REVIEW OF: Kropp F et al, J Subst Abuse Treat 2017;72:111–116

Contingency management (CM) programs are often effective, but they can be expensive, with typical incentives costing $900–$3,000 for a 12-week program. Expensive CM programs are referred to as “high magnitude.” In this new study, researchers tested an “ultra-low magnitude” program (basically, a very cheap program) to see if offering inexpensive reinforcers would be effective for an opioid-abusing clientele.

The staff of a methadone program in the Midwest were trying to improve the abysmal attendance at their optional therapy groups and 12-step groups—only about 6% of patients were showing up. The bare-bones budget allowed no more than $15 per week for incentives, so the team came up with the following system: Any patient who attended group was eligible to enter a raffle drawing for a free methadone dose, which normally required a $15 clinic copay. Attending multiple groups increased patients’ odds of winning.

From 503 to 544 patients participated in the study, depending on the month. A significant boost to overall attendance of groups was recorded at the first month (X2 = 5.78, odds ratio = 1.48) and at 6 months (X2 = 6.12, odds ratio = 1.49). No significant improvement was seen for clinician-led groups. However, the peer-led Methadone Anonymous (MA) groups did see a significant increase in attendance through the full 12 months of the intervention (X2 = 11.21, odds ratio = 3.86) and through the 3-month follow-up period after the intervention (X2 = 14.73, odds ratio = 4.49).

CATR’s Take
There were a few research design issues, such as a lack of a control comparison group, that weaken our confidence in the results a bit. And there is no proof that the increase in MA attendance led to lower relapse rates. Nonetheless, a very cheap program (it averaged $1 per patient per week) worked surprisingly well for increasing attendance, mainly at MA groups to increase treatment participation. Other proven ways to reduce costs of CM include using lottery tickets instead of high-magnitude prizes, because a smaller chance of a bigger prize seems to work as well as a bigger chance of a smaller prize. The ultra-low magnitude reinforcer study, though, is about as low as you can go with CM cost reduction. It’s well worth a try at other treatment programs.