Transcript Document
Contingency Management in Substance Misuse Services Andy Moore Locality Director What is it ? • The principle behind CM is that desired behaviours are systematically reinforced while undesired behaviours are discouraged • The theories underpinning CM are well over 50 years old. • In terms of the drug field, the 2007 Clinical Guidelines provide the following explanation: “Contingency management operates by providing a variety of incentives in the form of vouchers, privileges, prizes or modest financial incentives to modify a person’s drug misuse or to increase health promoting behaviours” 7/21/2015 7:56:39 AM 2 Evidence base • The evidence for the effectiveness of CM is substantial. In fact, according to NICE, it constitutes: “the largest single body of evidence for the effectiveness of psychosocial interventions in drug misuse” 7/21/2015 7:56:39 AM 3 Evidence base • In July 2007 NICE published two clinical guidelines – one on psychosocial interventions and one on detoxification. Both included recommendations that CM be introduced to drug services as part of an NTA-led implementation programme: 7/21/2015 7:56:39 AM 4 Putting it into practice • The keyworker’s attitude is as important as the incentive – Praise is as vital as the incentive – Talk up the importance of the incentives available – Help clients see how continued positive behaviour can help change their lives 7/21/2015 7:56:39 AM 5 Drug free CM • 12 week programme. • Reset to week 1 for positive test • Maximum of £108 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 7/21/2015 7:56:39 AM You can earn £2 per negative urine i.e. £6. You can earn £3 per negative urine i.e. £9 You can earn £4 per negative urine e.g. £12 You can earn £5 per negative urine e.g. £10 You can earn £6 per negative urine e.g. £12 You can earn £7 per negative urine e.g. £14 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 You can earn £8 You can earn £9 You can earn £10 You can earn £8 You can earn £6 You can earn £4 6 Drug free CM • 28 yr old man stable on Buprenorphine but using £50+ crack per week • 4/4 previous tests positive to Cocaine • Could not see a way forward until we mentioned CM • Completed the programme earned £75 • Transferred to primary care team, working full time used Crack 1-2 in last 6 months 7/21/2015 7:56:39 AM 7 Attendance CM • 27 year old single parent had dna’d or cancelled last 6/9 appointments • Attended all 12 of CM programme • Behaviour generalised to attendance at dentist, diabetic clinic • Enrolled on and completed evening class 7/21/2015 7:56:39 AM 8 Rewards • Clothes • Gifts for their children • Uniform for college course • Health/fitness club passes • Fridge, coffee maker, rug 7/21/2015 7:56:39 AM 9 Issues for staff • Attitude to rewards • Ability to give positive verbal rewards • Organisation of diary and work • Paperwork and maths • Practicalities of purchasing the incentives • Are we better set up to punish than reward? 7/21/2015 7:56:39 AM 10 Issues for service users • They understood the underlying principles and only 2 refused on “ethical grounds” • Very little complaint from those not on the programme • People still talk about what they spent their money/vouchers on 7/21/2015 7:56:39 AM 11