Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management

• Published in: Contemporary clinical trials Vol. 71; pp. 124 - 132
• Main Authors: Metrebian, N., Weaver, T., Pilling, S., Hellier, J., Byford, S., Shearer, J., Mitcheson, L., Astbury, M., Bijral, P., Bogdan, N., Bowden-Jones, O., Day, E., Dunn, J., Finch, E., Forshall, S., Glasper, A., Morse, G., Akhtar, S., Bajaria, J., Bennett, C., Bishop, E., Charles, V., Davey, C., Desai, R., Goodfellow, C., Haque, F., Little, N., McKechnie, H., Morris, J., Mosler, F., Mutz, J., Pauli, R., Poovendran, D., Slater, E., Strang, J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2018
• Subjects: Abstinence; Adult; Attendance; Behavior Therapy - methods; Buprenorphine - administration & dosage; Cluster Analysis; Contingency management; Drug Misuse - prevention & control; Drug Misuse - psychology; Female; Financial incentives; Heroin Dependence - psychology; Heroin Dependence - therapy; Heroin use; Humans; Male; Medication Therapy Management - organization & administration; Medication Therapy Management - standards; Mental Health Services - economics; Mental Health Services - organization & administration; Mental Health Services - standards; Methadone - administration & dosage; Narcotic Antagonists - administration & dosage; Opiate substitution treatment; Opiates; Opioid-Related Disorders - psychology; Opioid-Related Disorders - therapy; Positive reinforcement; Quality Improvement; Randomized Controlled Trials as Topic; Reinforcement, Psychology; United Kingdom; United Kingdom; Attendance; Positive reinforcement; Contingency management; Opiates; Financial incentives; Heroin use; Opiate substitution treatment; Abstinence
• ISSN: 1551-7144; 1559-2030
• DOI: 10.1016/j.cct.2018.06.008

There are approximately 256,000 heroin and other opiate users in England of whom 155,000 are in treatment for heroin (or opiate) addiction. The majority of people in treatment receive opiate substitution treatment (OST) (methadone and buprenorphine). However, OST suffers from high attrition and persistent heroin use even whilst in treatment. Contingency management (CM) is a psychological intervention based on the principles of operant conditioning. It is delivered as an adjunct to existing evidence based treatments to amplify patient benefit and involves the systematic application of positive reinforcement (financial or material incentives) to promote behaviours consistent with treatment goals. With an international evidence base for CM, NICE recommended that CM be implemented in UK drug treatment settings alongside OST to target attendance and the reduction of illicit drug use. While there was a growing evidence base for CM, there had been no examination of its delivery in UK NHS addiction services. The PRAISe trial evaluates the feasibility, acceptability, clinical and cost effectiveness of CM in UK addiction services. It is a cluster randomised controlled effectiveness trial of CM (praise and financial incentives) targeted at either abstinence from opiates or attendance at treatment sessions versus no CM among individuals receiving OST. The trial includes an economic evaluation which explores the relative costs and cost effectiveness of the two CM intervention strategies compared to TAU and an embedded process evaluation to identify contextual factors and causal mechanisms associated with variations in outcome. This study will inform UK drug treatment policy and practice. Trial registration ISRCTN 01591254.