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Donald A Calsyn - One of the best experts on this subject based on the ideXlab platform.

  • pre treatment characteristics program philosophy and level of ancillary services as predictors of methadone maintenance treatment outcome
    Addiction, 1996
    Co-Authors: Andrew J Saxon, Elizabeth A Wells, Charles B Fleming, Ron T Jackson, Donald A Calsyn
    Abstract:

    Predictors of methadone maintenance treatment outcome have not been extensively studied as they relate to variations in program philosophy, nor have such predictors received much examination among recently treated, older cohorts of opioid addicts for whom drug use patterns have changed. Predictors of outcome were examined at 18 months post-treatment entry for 353 admissions to methadone maintenance who received random assignment to one of three counseling conditions: (1) medication only, (2) standard counseling and (3) enhanced services; and one of two Contingency conditions: (1) no contingencies, and (2) Contingency Contracting in a six-cell 3 x 2 design. Subjects in Contingency Contracting conditions were placed on Contingency contracts for positive urine toxicology results and ultimately discharged for unremitting drug use. All subjects completed the Addiction Severity Index (ASI) and provided weekly urine specimens. Predictors of urinalysis results and treatment retention were determined using bivariate and multivariate techniques. Interactions between subject characteristics by experimental condition assignment were also examined as predictors. Higher rates of total positive urine specimens were predicted by younger age, greater pre-treatment frequency of smoking cocaine, lower ASI psychiatric composite scores, and higher ASI legal composite scores. Higher rates of opiate positive specimens were predicted by younger age, lower pre-treatment frequency of alcohol intoxication, higher ASI legal and lower ASI employment and psychiatric composite scores, and assignment to medication only/no contingencies condition. Higher rates of cocaine positives were predicted by younger age, black race, lower ASI psychiatric composite score, greater pre-treatment frequency of intravenous and smoked cocaine use, less pre-treatment frequency of marijuana use, and lower methadone dose level. Assignment to enhanced/Contingency Contracting predicted lower rates of cocaine positives. Treatment retention was predicted by older age, non-black race, lower ASI legal composite score, higher methadone dose level and assignment to non-contingent conditions. While subject variables over which treatment providers have little control were, thus, related to outcome, type of treatment provided and methadone dose also influenced outcome.

  • outcome of Contingency Contracting for illicit drug use in a methadone maintenance program
    Drug and Alcohol Dependence, 1993
    Co-Authors: Andrew J Saxon, Donald A Calsyn, Daniel R Kivlahan, Douglas K Roszell
    Abstract:

    This study evaluates the outcome of a mandatory, clinic wide, structured Contingency Contracting system in a methadone maintenance program. The system involved weekly urine screening and placement on written individualized contracts for any of 106 male patients who displayed illicit drug use. Methadone dose decreases were the penultimate and detoxification and discharge the ultimate contingencies for unremitting drug use. Sixty subjects (56.6%) received contracts and 36 (35%) eventually left treatment. The contracts did not decrease the overall number of positive urines for the contract subjects, but opiate use did decrease significantly for subjects on more stringent contracts.

Andrew J Saxon - One of the best experts on this subject based on the ideXlab platform.

  • pre treatment characteristics program philosophy and level of ancillary services as predictors of methadone maintenance treatment outcome
    Addiction, 1996
    Co-Authors: Andrew J Saxon, Elizabeth A Wells, Charles B Fleming, Ron T Jackson, Donald A Calsyn
    Abstract:

    Predictors of methadone maintenance treatment outcome have not been extensively studied as they relate to variations in program philosophy, nor have such predictors received much examination among recently treated, older cohorts of opioid addicts for whom drug use patterns have changed. Predictors of outcome were examined at 18 months post-treatment entry for 353 admissions to methadone maintenance who received random assignment to one of three counseling conditions: (1) medication only, (2) standard counseling and (3) enhanced services; and one of two Contingency conditions: (1) no contingencies, and (2) Contingency Contracting in a six-cell 3 x 2 design. Subjects in Contingency Contracting conditions were placed on Contingency contracts for positive urine toxicology results and ultimately discharged for unremitting drug use. All subjects completed the Addiction Severity Index (ASI) and provided weekly urine specimens. Predictors of urinalysis results and treatment retention were determined using bivariate and multivariate techniques. Interactions between subject characteristics by experimental condition assignment were also examined as predictors. Higher rates of total positive urine specimens were predicted by younger age, greater pre-treatment frequency of smoking cocaine, lower ASI psychiatric composite scores, and higher ASI legal composite scores. Higher rates of opiate positive specimens were predicted by younger age, lower pre-treatment frequency of alcohol intoxication, higher ASI legal and lower ASI employment and psychiatric composite scores, and assignment to medication only/no contingencies condition. Higher rates of cocaine positives were predicted by younger age, black race, lower ASI psychiatric composite score, greater pre-treatment frequency of intravenous and smoked cocaine use, less pre-treatment frequency of marijuana use, and lower methadone dose level. Assignment to enhanced/Contingency Contracting predicted lower rates of cocaine positives. Treatment retention was predicted by older age, non-black race, lower ASI legal composite score, higher methadone dose level and assignment to non-contingent conditions. While subject variables over which treatment providers have little control were, thus, related to outcome, type of treatment provided and methadone dose also influenced outcome.

  • outcome of Contingency Contracting for illicit drug use in a methadone maintenance program
    Drug and Alcohol Dependence, 1993
    Co-Authors: Andrew J Saxon, Donald A Calsyn, Daniel R Kivlahan, Douglas K Roszell
    Abstract:

    This study evaluates the outcome of a mandatory, clinic wide, structured Contingency Contracting system in a methadone maintenance program. The system involved weekly urine screening and placement on written individualized contracts for any of 106 male patients who displayed illicit drug use. Methadone dose decreases were the penultimate and detoxification and discharge the ultimate contingencies for unremitting drug use. Sixty subjects (56.6%) received contracts and 36 (35%) eventually left treatment. The contracts did not decrease the overall number of positive urines for the contract subjects, but opiate use did decrease significantly for subjects on more stringent contracts.

Sharon M Hall - One of the best experts on this subject based on the ideXlab platform.

  • a cost effectiveness and cost benefit analysis of Contingency Contracting enhanced methadone detoxification treatment
    American Journal of Drug and Alcohol Abuse, 1999
    Co-Authors: Diane T Hartz, Patricia Meek, Nancy A Piotrowski, Donald J Tusel, Curtis J Henke, Kevin L Delucchi, Karen L Sees, Sharon M Hall
    Abstract:

    We examined treatment costs in an ongoing study in which 102 opioid-addicted patients had been randomly assigned to either 180-day methadone detoxification or the same treatment enhanced with Contingency Contracting. In the latter condition, study participants received regular reinforcers contingent on negative urine toxicology screens and breath analyses for a range of drugs and alcohol. Both conditions involved psychosocial treatment, and all participants were stabilized to a daily methadone dose of approximately 80 mg during the first 4 months, followed by a 2-month taper. Individuals participating in the enhanced condition were more likely to provide continuously drug-free urine samples and alcohol-free breath samples during the final month of treatment than were participants in the control condition. Cost of treatment was calculated individually for each participant based on actual services received. First, unit cost for each service was determined, including adjusted staff salaries for direct treatment and opportunity cost of facilities utilized during service delivery. Next, we valued each patient's use of services during the first 120 days of the study and then added the cost of methadone, laboratory work, and contingent reinforcers. A subsample (n = 45) also provided data on health care utilization during treatment, which we valued using standard Medicare unit costs. The marginal cost of enhancing the standard treatment with Contingency Contracting was approximately 8%. An incremental cost of $17.27 produced an additional 1% increase in the number of participants providing continuously substance-free urine and breath samples during month 4 of the study. For every additional dollar spent on treatment, a $4.87 health care cost offset was realized; however, this difference was statistically insignificant due to extreme variances and small subsample size.

  • Contingency Contracting with monetary reinforcers for abstinence from multiple drugs in a methadone program
    Experimental and Clinical Psychopharmacology, 1999
    Co-Authors: Nancy A Piotrowski, Patricia Meek, Donald J Tusel, Karen L Sees, Patrick M Reilly, Peter Banys, Sharon M Hall
    Abstract:

    : Positive monetary contingencies for treating opioid dependence complicated by other drug use were examined. Participants (N = 102) entered 6-month methadone transition treatment (MTT) and were randomized into experimental conditions: 51 entered MTT with Contingency contracts using monetary reinforcers and targeting abstinence from illicit drug and alcohol use, and 51 entered MTT without Contingency contracts targeting abstinence. Outcomes were evaluated by random urinalysis and breath analysis. After 4 months of treatment, individuals in the Contingency condition had longer periods of continuous abstinence (p<.005) and more drug-free tests overall (p<.04). Effects were limited, however, to the Contracting period. The authors conclude that Contingency Contracting using monetary reinforcers may be a useful adjunct for achieving abstinence from multiple drugs of abuse during MTT.

Nancy A Piotrowski - One of the best experts on this subject based on the ideXlab platform.

  • a cost effectiveness and cost benefit analysis of Contingency Contracting enhanced methadone detoxification treatment
    American Journal of Drug and Alcohol Abuse, 1999
    Co-Authors: Diane T Hartz, Patricia Meek, Nancy A Piotrowski, Donald J Tusel, Curtis J Henke, Kevin L Delucchi, Karen L Sees, Sharon M Hall
    Abstract:

    We examined treatment costs in an ongoing study in which 102 opioid-addicted patients had been randomly assigned to either 180-day methadone detoxification or the same treatment enhanced with Contingency Contracting. In the latter condition, study participants received regular reinforcers contingent on negative urine toxicology screens and breath analyses for a range of drugs and alcohol. Both conditions involved psychosocial treatment, and all participants were stabilized to a daily methadone dose of approximately 80 mg during the first 4 months, followed by a 2-month taper. Individuals participating in the enhanced condition were more likely to provide continuously drug-free urine samples and alcohol-free breath samples during the final month of treatment than were participants in the control condition. Cost of treatment was calculated individually for each participant based on actual services received. First, unit cost for each service was determined, including adjusted staff salaries for direct treatment and opportunity cost of facilities utilized during service delivery. Next, we valued each patient's use of services during the first 120 days of the study and then added the cost of methadone, laboratory work, and contingent reinforcers. A subsample (n = 45) also provided data on health care utilization during treatment, which we valued using standard Medicare unit costs. The marginal cost of enhancing the standard treatment with Contingency Contracting was approximately 8%. An incremental cost of $17.27 produced an additional 1% increase in the number of participants providing continuously substance-free urine and breath samples during month 4 of the study. For every additional dollar spent on treatment, a $4.87 health care cost offset was realized; however, this difference was statistically insignificant due to extreme variances and small subsample size.

  • Contingency Contracting with monetary reinforcers for abstinence from multiple drugs in a methadone program
    Experimental and Clinical Psychopharmacology, 1999
    Co-Authors: Nancy A Piotrowski, Patricia Meek, Donald J Tusel, Karen L Sees, Patrick M Reilly, Peter Banys, Sharon M Hall
    Abstract:

    : Positive monetary contingencies for treating opioid dependence complicated by other drug use were examined. Participants (N = 102) entered 6-month methadone transition treatment (MTT) and were randomized into experimental conditions: 51 entered MTT with Contingency contracts using monetary reinforcers and targeting abstinence from illicit drug and alcohol use, and 51 entered MTT without Contingency contracts targeting abstinence. Outcomes were evaluated by random urinalysis and breath analysis. After 4 months of treatment, individuals in the Contingency condition had longer periods of continuous abstinence (p<.005) and more drug-free tests overall (p<.04). Effects were limited, however, to the Contracting period. The authors conclude that Contingency Contracting using monetary reinforcers may be a useful adjunct for achieving abstinence from multiple drugs of abuse during MTT.

Marilyn H Oermann - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness of Contingency Contracting component of a worksite weight loss program
    AAOHN Journal, 1996
    Co-Authors: Gail Landheer Zandee, Marilyn H Oermann
    Abstract:

    The purpose of this study was to measure weight loss in overweight employees of a large corporation in Western Michigan who all received the same education on how to lose weight, but were randomly assigned to one of three groups: Contingency Contracting with a partner, Contingency Contracting alone, or no Contingency Contracting. A pretest-posttest quasi-experimental design was used and data were collected by a demographic questionnaire and measure of weight at the initial, 10th, and 23rd weeks. A total of 84 subjects completed the 10 week weight loss program and 57 subjects returned for the 23rd week follow up weight. Each group lost a significant amount of weight from pre-program to 10 weeks; however, there were no significant differences across groups. Although the groups were not significantly different from each other, the results support the value of individualizing interventions and offer insight into how demographic variables may affect attrition and methods chosen for weight loss.