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A Closer Look: Q&A with Hendrée E. Jones

Hendree JonesHendrée E. Jones is a Senior Research Psychologist at RTI International as well as a professor at Johns Hopkins University School of Medicine.  Dr. Jones and colleagues published a recent study that found drug abstinence among pregnant women with heroin or cocaine addiction can be promoted by a “contingency management” approach, which offers incentives for women when their drug tests come out negative.

Please describe the contingency management approach to drug treatment for pregnant women with cocaine or heroin addiction that you researched.

We researched two common types of contingency management for improving abstinence from cocaine and illegitimate opioid use.  One was a fixed monetary voucher of $25 for a negative drug test (tests were given three days a week) and the other an escalating monetary voucher, starting at $7.50, which employs a resetting mechanism whereby a positive drug test resulted in zero earnings and a return to the lowest amount earned.  The inclusion of the resetting mechanism appears to provide additional benefits as individuals want to avoid having the reset occur.  Tests were given three days a week and participants could exchange their vouchers for merchandise or gift certificates.  We have also found that we can dramatically reduce cigarette smoking among methadone maintained pregnant patients by using the escalating contingency management format in a manner where we monetarily reinforce gradual reductions of cigarette smoking over a 12-week period.  Due to the small sample size of the study and methodological issues, the findings of the study, while promising, were not statistically significant. Future research needs to address a number of issues, including the amount of the voucher incentive that might prove maximally effective, particularly in the context of a reset; what behavioral treatments might best be combined with a contingency management approach to reduce smoking; and the long-term impact of a contingency management approach in reducing smoking.

What did you think are the most important elements of CM in order for it to be an effective intervention?

For contingency management to work well, a desirable tangible good, like a gift certificate or money, should be delivered to the person immediately following their attainment of the select target behavior. Additionally, the magnitude of the reinforcement should be consistent with the behavioral demand.  For example, one penny is not likely to be valued enough by a person for them to provide a drug negative urine sample.

What are the long term outcomes for CM? In other words, what are your thoughts about whether women continue to stay drug free once incentives are stopped?

Contingency management can be highly effective in initiating and sustaining drug abstinence during the time it is in place in the person’s life. Some studies have shown that contingency management interventions lead to sustained drug abstinence. One recent study by Nancy Petry and John Roll showed that participants who won greater amounts of prizes during treatment, even after controlling for longest duration of abstinence achieved, were significantly more likely than those who won lower amounts of prizes to maintain their drug abstinence after contingency management was discontinued. Other studies have not demonstrated lasting effects after CM has been removed. Further research may be able to isolate the specific conditions that contribute to long-term success.

If an agency would like to use this approach, what are your recommendations for getting started and how can they learn more?

From what I hear from providers around the country and internationally, the awareness and use of contingency management is growing.   People can go to http://www.bettertxoutcomes.org, to access a free collection of tools, called Motivational Incentives-A Proven Approach to Treatment, developed by NIDA and SAMHSA.  The collection of products assists organizations in learning about and using Contingency Management.

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