A Randomized Trial of Adjunct mHealth Abstinence Reinforcement With Transdermal Nicotine and Counseling for Smoking Cessation Nationwide access to an internet‐based contingency management intervention to promote smoking cessation: a randomized controlled trial Multicomponent smoking cessation treatment including mobile contingency management in homeless veterans. A randomized trial of computer-delivered brief intervention and low-intensity contingency management for smoking during pregnancy. Mobile contingency management as an adjunctive smoking cessation treatment for smokers with posttraumatic stress disorder. A deposit contract method to deliver abstinence reinforcement for cigarette smoking. Improved adherence with contingency management. Using contingency management procedures to reduce at-risk drinking in heavy drinkers. Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial. Use of continuous transdermal alcohol monitoring during a contingency management procedure to reduce excessive alcohol use. A randomized study of cellphone technology to reinforce alcohol abstinence in the natural environment. Effect of incentives for medication adherence on health care use and costs in methadone patients with HIV. Remote Alcohol Monitoring to Facilitate Incentive‐Based Treatment for Alcohol Use Disorder: A Randomized Trial
Introduction Abstinence reinforcement is efficacious for improving smoking treatment outcomes , but practical constraints related to the need for multiple in-person carbon monoxide ( CO ) breath tests daily to verify smoking abstinence have limited its use . This study tested an mHealth procedure to remotely monitor and reinforce smoking abstinence in individuals ' natural environment . Methods Eligible treatment-seeking smokers ( N = 90 ) were r and omized to ( 1 ) usual care and ecological monitoring with abstinence reinforcement ( mHealth reinforcement ) or ( 2 ) without reinforcement ( mHealth monitoring ) . Usual care was 8 weeks of transdermal nicotine and twice-weekly telephone counseling . Following training , an interactive voice response system prompted participants to conduct CO tests 1 - 3 daily at pseudor and om times ( 7 am to 10 pm ) for 4 weeks . When prompted , participants used a study cell phone and CO monitor to complete a CO self-test , video record the process , and su bmi t videos using multimedia messaging . mHealth reinforcement participants could earn prizes for smoking-negative on-time CO tests . The interactive voice response generated preliminary earnings immediately . Earnings were finalized by comparing video records against participants ' self-reports . Results mHealth reinforcement was associated with a greater proportion of smoking-negative CO tests , longest duration of prolonged abstinence , and point-prevalence abstinence during the monitoring/reinforcement phase compared to mHealth monitoring ( p < .01 , d = 0.8 - 1.3 ) . Follow-up ( weeks 4 - 24 ) analyses indicated main effects of reinforcement on point-prevalence abstinence and proportion of days smoked ( p ≤ .05 ) ; values were comparable by week 24 . Conclusions mHealth reinforcement has short-term efficacy . Research on methods to enhance and sustain benefits is needed . Implication s This study suggests that mHealth abstinence reinforcement is efficacious and may present temporal and spatial opportunities to research , engage , and support smokers trying to quit that do not exist with conventional ( not technology-based ) reinforcement interventions Background and aims Contingency management ( CM ) is one of the most effective behavioral interventions to promote drug abstinence , but availability of this treatment is limited . We evaluated the efficacy and acceptability of internet‐based CM relative to an internet‐based monitoring and goal ‐ setting control group in a nationwide sample of cigarette smokers . Design R and omized controlled trial with 3‐ and 6‐month follow‐ups . Setting United States . Participants Smokers ( n = 94 ) from 26 states were enrolled ( mean age 36 , 56 % female ) . Intervention and comparator Participants were r and omized to earn financial incentives ( up to $ 480 over 7 weeks ) based on video‐verified abstinence using breath carbon monoxide ( CO ) output ( n = 48 ; abstinent contingent group , AC ) , or based on su bmi tting CO sample s ( n = 46 , su bmi ssion contingent , SC ) . Both groups also received the same CO‐based goals . A $ 50 deposit was required in both groups that could be recouped from initial earnings . Measures The primary outcome was point prevalence at week 4 . Secondary outcomes were point prevalence at the 3‐ and 6‐month follow‐ups , percentages of negative CO sample s , adherence to the CO sampling protocol , and treatment acceptability ratings on a 0–100‐mm visual analog scale . Findings Abstinence rates differed at 4 weeks between the AC ( 39.6 % ) and SC ( 13.0 % ) groups [ odds ratio ( OR ) = 4.4 , 95 % confidence interval ( CI ) = 1.6–12.3 ] , but not at the 3‐ ( 29.2 % AC and 19.6 % SC , OR = 1.7 , 95 % CI = 0.6–4.4 ) or 6‐ ( 22.9 % AC and 13.0 % SC , OR = 2.0 , 95 % CI = 0.7–5.9 ) month follow‐ups . During the two main treatment phases , there were significant differences in negative COs ( 53.9 % AC and 24.8 % SC , OR = 3.5 , 95 % CI = 3.1–4.0 ; 43.4 % AC and 24.6 % SC , OR = 2.3 , 95 % CI = 1.6–3.4 ) . Adherence to the CO su bmi ssion protocol was equivalent ( 78 % AC and 85 % SC , difference = 7.0 % , 95 % CI = −10.3 to 23.8 % , F < 1 , P = 0.39 ) . The lowest acceptability ratings were for the items assessing the deposit , whereas the highest ratings concerned the ease of the intervention , the graph of CO results , and earning money . Conclusions A contingency management/financial incentive program delivered via the internet improved short‐term abstinence rates compared with an internet program without the incentives INTRODUCTION Smoking rates are 80 % among persons who are homeless , and these smokers have decreased odds of quitting smoking . Little is known about relapse rates among homeless smokers . More information is needed regarding both quit rates and innovative methods to treat smoking cessation among homeless smokers .  Web-based contingency management ( CM ) approaches have been found helpful in reducing smoking among other difficult-to-treat smoker population s but have been generally limited by the need for computers or frequent clinic-based carbon monoxide ( CO ) monitoring . This open pilot study builds on a web-based CM approach by evaluating a smartphone-based application for CM named mobile CM ( mCM ) . The study was conducted from January 1 , 2013-April 15 , 2014 . METHOD Following a 1-week training period , 20 homeless veteran smokers ( ≥ 10 cigarettes daily for 1 year or more and a CO baseline level ≥ 10 ppm ) participated in a multicomponent smoking cessation intervention including 4 weeks of mCM . All smokers received 4 smoking cessation counseling sessions , nicotine replacement , and bupropion ( if medically eligible ) . Participants could earn up to $ 815 ( $ 480 for mCM , $ 100 for CO readings showing abstinence [ ie , 6 ppm or less ] at posttreatment and follow-up , and $ 35 for equipment return ) . RESULTS Mean compensation for the mCM component was $ 286 of a possible $ 480 . Video transmission compliance was high during the 1-week training ( 97 % ) and the 4-week treatment period ( 87 % ) . Bioverified 7-day point prevalence abstinence was 50 % at 4 weeks . Follow-up bioverified single assessment point prevalence abstinence was 55 % at 3 months and 45 % at 6 months . CONCLUSIONS Results of this open pilot study suggest that mCM may be a useful adjunctive smoking cessation treatment component for reducing smoking among homeless veterans . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01789710 INTRODUCTION Implementation of evidence -based interventions for smoking during pregnancy is challenging . We developed 2 highly replicable interventions for smoking during pregnancy : ( a ) a computer-delivered 5As-based brief intervention ( CD-5As ) and ( b ) a computer-assisted , simplified , and low-intensity contingency management ( CM-Lite ) . METHODS A sample of 110 primarily Black pregnant women reporting smoking in the past week were recruited from prenatal care clinics and r and omly assigned to CD-5As ( n = 26 ) , CM-Lite ( n = 28 ) , CD-5As plus CM-Lite ( n = 30 ) , or treatment as usual ( n = 26 ) . Self-report of smoking , urine cotinine , and breath CO were measured 10 weeks following r and omization . RESULTS Participants rated both interventions highly ( e.g. , 87.5 % of CD-5As participants reported increases in likelihood of quitting ) , but most CM-Lite participants did not initiate reinforcement sessions and did not show increased abstinence .  CD-5As led to increased abstinence as measured by cotinine ( 43.5 % cotinine negative vs. 17.4 % ; odds ratio [ OR ] = 10.1 , p = .02 ) but not for CO-confirmed 7-day point prevalence ( 30.4 % abstinent vs. 8.7 % ; OR = 5.7 , p = .06 ) . Collapsing across CM-Lite status , participants receiving the CD-5As intervention were more likely to talk to a doctor or nurse about their smoking ( 60.5 % vs. 30.8 % ; OR = 3.0 , p = .02 ) . CONCLUSIONS Low-intensity participant-initiated CM did not affect smoking in this sample , but the CD-5As intervention was successful in increasing abstinence during pregnancy . Further research should seek to replicate these results in larger and more diverse sample s. Should CD-5As continue to prove efficacious , it could greatly increase the proportion of pregnant smokers who receive an evidence -based brief intervention INTRODUCTION Smokers with posttraumatic stress disorder ( PTSD ) smoke at higher prevalence rates and are more likely to relapse early in a quit attempt . Innovative methods are needed to enhance quit rates , particularly in the early quit period . Web-based contingency-management ( CM ) approaches have been found helpful in reducing smoking among other difficult-to-treat smoker population s but are limited by the need for computers . This pilot study builds on the web-based CM approach by evaluating a smartphone-based application for CM named mobile CM ( mCM ) . METHODS Following a 2-week training period , 22 smokers with PTSD were r and omized to a 4-week mCM condition or a yoked ( i.e. , noncontingent 4-week mCM condition ) . All smokers received 2 smoking cessation counseling sessions , nicotine replacement , and bupropion . Participants could earn up to $ 690 ( $ 530 for mCM , $ 25.00 for assessment s and office visits [ up to 5 ] , and $ 35.00 for equipment return ) . The average earned was $ 314.00 . RESULTS Compliance was high during the 2-week training period ( i.e. , transmission of videos ) ( 93 % ) and the 4-week treatment period ( 92 % ) . Compliance rates did not differ by group assignment . Four-week quit rates ( verified with CO ) were 82 % for the mCM and 45 % for the yoked controls . Three-month self-report quit rates were 50 % in the mCM and 18 % in the yoked controls . CONCLUSIONS mCM may be a useful adjunctive smoking cessation treatment component for reducing smoking among smokers with PTSD , particularly early in a smoking quit attempt Eight smokers were r and omly assigned to a deposit contract ( $ 50.00 ) or to a no-deposit group . Using a reversal design , participants could recoup their deposit ( deposit group ) or earn vouchers ( no-deposit group ) for smoking reductions and abstinence ( breath carbon monoxide [ CO ] < or = 4 parts per million ) during treatment phases . Treatment was delivered via a novel Internet-based method to monitor smoking status . Although equivalent decreases in breath CO and abstinence were observed during treatment in both groups , $ 178.50 in vouchers were distributed to participants in the no-deposit group , whereas a small surplus remained in the deposit group . A deposit contract method may represent a cost-effective model to deliver abstinence reinforcement for cigarette smoking Contingency management ( CM ) based interventions that reinforce adherence to prescribed medications have shown promise in a variety of disadvantaged population s. Fifty-six participants with histories of illicit substance use who were prescribed antiretroviral medication but evidence d suboptimal adherence during a baseline assessment were r and omly assigned to 16 weeks of weekly CM-based counseling or supportive counseling , followed by 16 additional weeks of data collection and adherence feedback to providers . The CM intervention involved review of data generated by electronic pill-bottle caps that record bottle opening ( MEMS ) and brief substance abuse counseling . CM participants were reinforced for MEMS-measured adherence with drawings from a bowl for prizes and bonus drawings for consecutive weeks of perfect adherence . Potential total earnings averaged $ 800 . Mean MEMS-measured adherence to the reinforced medication increased from 61 % at baseline to 76 % during the 16-week treatment phase and was significantly increased relative to the supportive counseling group ( p = 0.01 ) . Furthermore , mean log-transformed viral load was significantly lower in the CM group . However , by the end of the 16-week follow-up phase , differences between groups in adherence and viral load were no longer significantly different . Proportions of positive urine toxicology tests did not differ significantly between the two groups at any phase . A brief CM-based intervention was associated with significantly higher adherence and lower viral loads . Future studies should evaluate methods to extend effects for longer term benefits BACKGROUND Treatments for alcohol use disorders typically have been abstinence based , but harm reduction approaches that encourage drinkers to alter their drinking behavior to reduce the probability of alcohol-related consequences , have gained in popularity . This study used a contingency management procedure to determine its effectiveness in reducing alcohol consumption among heavy drinkers . METHODS Eighty-two nontreatment-seeking heavy drinkers ( ages 21 to 54 , M = 30.20 ) who did not meet diagnostic criteria for alcohol dependence participated in the study . The study had 3 phases : ( i ) an Observation phase ( 4 weeks ) where participants drank normally ; ( ii ) a Contingency Management phase ( 12 weeks ) where participants were paid $ 50 weekly for not exceeding low levels of alcohol consumption as measured by transdermal alcohol concentrations , < 0.03 g/dl ; and ( iii ) a Follow-up phase ( 12 weeks ) where participants ( n = 66 ) returned monthly for 3 months to self-report drinking after the contingencies were removed . Transdermal alcohol monitors were used to verify meeting contingency requirements ; all other analyses were conducted on self-reported alcohol use . RESULTS On average 42.3 % of participants met the contingency criteria and were paid an average of $ 222 during the Contingency Management phase , with an average $ 1,998 in total compensation throughout the study . Compared to the Observation phase , the percent of any self-reported drinking days significantly decreased from 59.9 to 40.0 % in the Contingency Management and 32.0 % in the Follow-up phases . The percent of self-reported heavy drinking days reported also significantly decreased from 42.4 % in the Observation phase to 19.7 % in the Contingency Management phase , which was accompanied by a significant increase in percent days of self-reported no ( from 40.1 to 60.0 % ) and low-level drinking ( from 9.9 to 15.4 % ) . Self-reported reductions in drinking either persisted , or became more pronounced , during the Follow-up phase . CONCLUSIONS Contingency management was associated with a reduction in self-reported episodes of heavy drinking among nontreatment-seeking heavy drinkers . These effects persisted even after incentives were removed , indicating the potential utility of contingency management as a therapeutic intervention to reduce harmful patterns of drinking This clinical trial evaluated a contingency management intervention design ed to improve medication adherence among HIV-positive methadone maintenance patients . After a 4-week baseline observation phase , eligible participants ( N=66 ) were r and omly assigned to : ( a ) medication coaching sessions every other week to assist with adherence strategies ( comparison group ) or ( b ) medication coaching plus voucher reinforcement for opening electronic medication caps on time ( voucher group ) . Baseline adherence ( percent doses taken/percent total possible doses ) was 51 % using electronic measurement , 75 % using self-report and 75 % using pill count . The intervention was provided for 12 weeks , with a 4-week follow-up . The primary outcome results of the clinical trial indicated effectiveness during the intervention , with significant mean adherence differences between voucher and comparison groups using electronic measurement ( 78 % versus 56 % ) , pill count ( 86 % versus 75 % ) , and self-report ( 87 % versus 69 % ) . Differences between groups faded after vouchers were discontinued . Contingency management shows promise as a strategy to promote antiretroviral medication adherence in this population BACKGROUND Research on contingency management to treat excessive alcohol use is limited due to feasibility issues with monitoring adherence . This study examined the effectiveness of using transdermal alcohol monitoring as a continuous measure of alcohol use to implement financial contingencies to reduce heavy drinking . METHODS Twenty-six male and female drinkers ( from 21 to 39 years old ) were recruited from the community . Participants were r and omly assigned to one of the two treatment sequences . Sequence 1 received 4 weeks of no financial contingency ( i.e. , $ 0 ) drinking followed by 4 weeks each of $ 25 and then $ 50 contingency management ; Sequence 2 received 4 weeks of $ 25 contingency management followed by 4 weeks each of no contingency ( i.e. , $ 0 ) and then $ 50 contingency management . During the $ 25 and $ 50 contingency management conditions , participants were paid each week when the Secure Continuous Remote Alcohol Monitor ( SCRAM-II ™ ) identified no heavy drinking days . RESULTS Participants in both contingency management conditions had fewer drinking episodes and reduced frequencies of heavy drinking compared to the $ 0 condition . Participants r and omized to Sequence 2 ( receiving $ 25 contingency before the $ 0 condition ) exhibited less frequent drinking and less heavy drinking in the $ 0 condition compared to participants from Sequence 1 . CONCLUSIONS Transdermal alcohol monitoring can be used to implement contingency management programs to reduce excessive alcohol consumption AIMS Contingency management ( CM ) uses tangible incentives to systematic ally reinforce abstinence and is among the most efficacious psychosocial substance abuse treatments . This study assessed the feasibility and initial efficacy of a portable CM procedure design ed to address technical limitations for detecting drinking that have prevented using CM for alcohol problems . DESIGN Participants received a cellphone , breathalyzer and training on video-recording alcohol breath tests ( BrACs ) and texting results . For 4 weeks , staff texted participants one to three times daily indicating that a breath alcohol concentration test ( BrAC ) was due within the hour . Participants were r and omized to ( 1 ) modest compensation for su bmi tting date d time-stamped BrAC videos regardless of results or ( 2 ) the same plus CM with escalating vouchers for on-time alcohol-negative tests ( n-BrAC ; < 02 g/dl ) . ' Thank-you ' texts were sent , with CM patients also informed of results -based earnings . SETTING Participants ' natural environment . PARTICIPANTS Adults ( n = 30 ; ≥ 21 years ) who drank frequently but were not physiologically dependent .  MEASUREMENTS Drinking and related problems were assessed at intake and week 4 . BrACs and self-reports of drinking were collected throughout . The primary outcome was the percentage of n-BrACs . Other outcomes were the longest duration of consecutive n-BrACs ( longest duration of abstinence ) and self-reports of drinking . FINDINGS On average , 88.6 % ( 10.4 % ) of BrACs were su bmi tted on time , without group differences ( P = 0.18 ) . The percentage of n-BrACs and LDA were greater with CM , and there was an interaction effect on drinking frequency and negative consequences , with decreases over time with CM ( P = 0.00 ; effect sizes d = 0.52 - 0.62 ) . CONCLUSION Cellphone technology may be useful for extending contingency management to treatment for alcohol problems BACKGROUND The potential benefits of anti-retroviral therapy for HIV is not fully realized because of difficulties in adherence with dem and ing treatment regimens , especially among injection drug users . METHODS HIV-positive methadone patients who were less than 80 % adherent with their primary anti-retroviral therapy  were r and omized to a trial of incentives for on-time adherence . Adherence was rewarded with an escalating scale of vouchers redeemable for goods . Both intervention and control group visited a medication coach twice a month . The cost of the intervention was determined by micro-costing . Other costs were obtained from administrative data and patient report of out-of-system care . RESULTS During the 12-week intervention period , the incremental direct cost of the intervention , including treatment vouchers , was $ 942 . The voucher group incurred $ 2572 in anti-retroviral drug cost , significantly more than the $ 1973 incurred by the comparison group ( p<.01 ) . Adherence , as measured by on-time openings of an electronically monitored vial , was 78 % in the intervention group and 56 % in the control group . CONCLUSIONS The incremental direct cost of voucher incentives was $ 292 per month . If the observed increase in adherence from voucher incentives can be sustained in the long-term , the literature suggests that disease progression will be slowed . Further research is needed to evaluate if the improvement can be sustained or achieved at lower cost . Mitigation of treatment resistance and reduction in HIV transmission are additional benefits that favor adoption Background The delivery of monetary incentives contingent on verified abstinence is an effective treatment for alcohol use disorder . However , technological barriers to accurate , frequent biochemical verification of alcohol abstinence have limited the dissemination of this technique . Methods In the present r and omized parallel trial , we employed a breathalyzer that allows remote , user‐verified collection of a breath alcohol sample , text messaging , and reloadable debit cards for remote delivery of incentives to evaluate a contingency management treatment for alcohol use disorder that can be delivered with no in‐person contact . Treatment‐seeking participants with alcohol use disorder ( n = 40 ) were recruited from the community and r and omized to either a contingent or a noncontingent group ( n = 20 each ) . The contingent group received nearly immediate monetary incentives each day they remotely provided negative breathalyzer sample s. The noncontingent group received matched monetary payments each day they successfully provided sample s independent of alcohol content . Groups were not masked as awareness of group contingencies was an essential intervention component . Results The primary outcome of the intent‐to‐treat analyses ( analyzed n = 40 ) was percent days abstinent as measured by the remote breathalyzer sample s. Abstinence rates in the contingent group were 85 % , which was significantly higher than the 38 % recorded in the noncontingent group , corresponding to an odds ratio of 9.4 ( 95 % CI = 4.0 to 22.2 ) . Breathalyzer collection adherence rates were over 95 % , and participant ratings of acceptability were also high . Conclusions These results support the efficacy , acceptability , and feasibility of this remotely deliverable abstinence reinforcement incentive intervention for the initiation and near‐term maintenance of abstinence from alcohol in adults with alcohol use disorder . Due to low provider and participant burden , this procedure has the potential for broad dissemination
Abstract Background / aims Contingency management ( CM ) interventions have gained considerable interest due to their success in the treatment of addiction .
However , their implementation can be re source ‐intensive for clinical staff .
Mobile telephone‐based systems might offer a low‐cost alternative .
This approach could facilitate remote monitoring of behaviour and delivery of the reinforcer and minimize issues of staffing and re sources .
This systematic review and meta‐ analysis assessed the evidence for the effectiveness of mobile telephone‐delivered CM interventions to promote abstinence ( from drugs , alcohol and tobacco ) , medication adherence and treatment engagement among individuals with substance use disorders .