Regional Demonstration Project 1
Researchers and service providers recognize that drop-out is perhaps the most common outcome of specialty substance misuse (SM)/addiction treatment – regardless of type of intervention offered or service context. The most innovative evidence-based pharmacotherapies or psychosocial treatment interventions stand little chance of reducing the individual and population burden of SM/addiction unless new approaches to address client engagement and retention in treatment are developed. Interventions targeting motivational processes are promising, and important strategies include implementing protocols that characterize the client case mix in relation to initial treatment motivations and incorporating motivational enhancement and contingency management interventions into treatment programs to increase adherence, retention, and client engagement. A thematic focus on motivation is supported by consistent evidence that treatment motivation predicts initial client engagement in SM/addiction programs and that client retention, in turn, is a robust predictor of positive post-treatment outcomes.
Evidence for the efficacy of using motivational interviewing (MI) interventions and contingency management (CM) protocols for increasing participation and quality of client outcomes is also well established. MI interventions have been widely disseminated, in part because individual practitioners can integrate the techniques into routine clinical activities. However, there is continuing concern about whether MI is effectively implemented by practitioners after training workshop. CM has been less widely adopted because it requires structural program changes and considerable resources to provide motivational incentives. It also requires broadening of treatment models to acknowledge the impact of external reinforcers in addition to the intrinsic motivation that clients bring to treatment, a shift that some treatment personnel, in some situations, resist. Because of these issues, the potential benefit of MI and CM interventions for promoting client retention in treatment is unrealized and only sporadic attempts have been made to adapt these interventions to the Canadian treatment context.
This project will focus on adapting contingency management (CM) interventions to the Canadian treatment context to enable more widespread adoption with high levels of fidelity. Treatment sites will be chosen from across the Prairie region, i.e., treatment agencies or programs that want to address issues of motivation and retention within their settings. Sites will be chosen to reflect diversity in geography, special populations (e.g., women, youth) and/or treatment focus (e.g., outpatient substance abuse, opioid replacement clinic).
- In Phase 1 (2017-2018), we worked with program personnel from 5 setting to provide training on CM and to explore how CM techniques and principles could be adapted for implementation into existing programming. Published training materials (e.g., NIDA Blending Team Products) for CM will be further developed, adapted, and piloted to develop user-friendly protocols, and training and resource needs will be determined.
- To date we have collected data from 5 sites (4 in Alberta and 1 in Saskatchewan) and are planning pilot projects with 4 of them in Phase 2.
- In Phase 2 (2018-2019), we will work with the sites to implement CM into their programs and to develop appropriate evaluation methods for each site. Participating programs will be provided with support from Prairie Node research staff to facilitate efficient data collection, as well as a CM reinforcement budget. Results will be used to further refine the training, supervision, and treatment models as well as refinement of training materials.
This project was recently presented at the CRISM Prairie Node 2nd Annual Gathering held Nov 15-16, 2017 in Calgary, AB.
Further information on MI and CM can be found on the NIDA CTN site: https://www.drugabuse.gov/nidasamhsa-blending-initiative
An informative video about CM is available here: http://www.bettertxoutcomes.org/bettertxoutcomes/PAMI.html