Despite strong support for its effectiveness, debates persist about the most effective ways to disseminate and design contingency management (CM) programs. Currently-promoted CM methods are empirically-validated, but their congruence with the actual interests and preferences of addiction treatment clients is unknown.
This study of clients in 3 community treatment programs in the Pacific Northwest Node of the NIDA Clinical Trials Network aimed to ask the question: what do clients actually want?
The study included anonymous survey completion by an aggregate sample of 358 enrollees, documenting interest in incentives and preferences for:
- fixed-ratio vs. variable-ratio (i.e., would you rather earn $5 a week for 10 weeks, or participate in a weekly drawing in which you could earn $50 each week?), and
- immediate vs. delayed distribution of earned incentives (i.e., would you rather earn $5 per week for 10 weeks, or save weekly points for 10 weeks to earn $50 at the end?).
Analyses ruled out site differences in survey responses, and then tested age and gender as influences.
Results found that:
- interest in different types of $50 vouchers (e.g., retail vouchers, transportation vouchers, cash) was highly inter-correlated, with a mean sample rating of 3.49 on a 5-point scale;
- gender did not influence client interest in incentives, but age was an inverse predictor, with youth exhibiting more interest than older clients;
- a majority of clients preferred fixed-ratio incentives and delayed distribution (67% and 63% respectively);
- those preferences were voiced by a majority of both men and women, but were held by a greater proportion of females.
Conclusions: This study offered a helpful glimpse into client perspectives about design features of contingency management interventions, and found that those preferences contradicted currently-promoted CM design features, which typically suggest variable-ratio (weekly drawings where you may receive more or less than the fixed amount) and immediate rewards are more effective. Future efforts to disseminate CM may be more successful if flexibly undertaken in a manner that incorporates the interests and preferences of local client populations.
Citation: Hartzler B, Garrett SB. Interest and Preferences for Contingency Management Design Among Addiction Treatment Clientele. American Journal of Drug and Alcohol Abuse 2015 (in press).