Good News for our Friends with Addictions!
Contingency Management
OK, here is some good news. Experts have developed an approach that is markedly more effective for treating methamphetamine and cocaine addiction, collectively referred to as stimulant addiction. This is important because we haven't had any really good methods in the past for treating stimulant addiction.
We already have good treatment options
for narcotic and alcohol addiction.
We have good medication assisted treatment for narcotic or opioid addiction. Traditional programs for narcotic addictions are abstinence based and rely on will power and motivation, and have a 4-7% success rate, which is quite low. When we use medication to assist the treatment, such as Suboxone, the success rate jumps to about 50%. In other words, medication assisted treatment for narcotic addiction using Suboxone, is about 10 times more successful than traditional therapy alone. Medication assisted therapy is the preferred, first line therapy for narcotic addiction.
Suboxone blocks the negative aspects of withdrawal, and by using Suboxone addicts are able return to work and be productive members of society. Suboxone has some dangers itself, but is much safer than the narcotics, such as oxycodone, heroin or fentanyl they most Suboxone users were addicted to. Other FDA approved options include naltrexone or methadone which are also very helpful for people that want to overcome their addiction.
We also have good treatment options for alcohol. There are at least 5 drugs alcoholics can use to to help overcome their addiction. Some of these drugs reduce alcohol craving, and some cause discomfort if they consume alcohol again. So alcoholics have a number of medicines to choose from, and most can find a medication that will be helpful to them.
Of course all of these medications for narcotic and alcohol addiction are used along with traditional therapy as needed. That might include attending group therapy meetings, or AA meetings or in-patient rehab, or individual counseling.
But people with stimulant addiction, (meth and cocaine), don't have any FDA approved drugs to help them overcome their addiction. This is a serious problem, because in some states methamphetamine is the number 1 cause of overdose deaths. So what is the good news for stimulant addicts?
Contingency Management!
Contingency management is a behavioral treatment based on operant conditioning principles. Most commonly, the treatment provides something of monetary value to patients to incentivize them to not use drugs.
For instance, when they produce a urine sample that is negative for stimulants, patients might be given a reward such as a trinket of small value or maybe a movie ticket. Or a gift card that might be good for $5 at MacDonald's. The amazing things is, these rewards are not of huge value, but they seem to really work. Patients in these Contingency Management programs have higher success rates, about 50% higher, when compared to traditional therapy alone (SAMHSA Publication No. PEP21-02-01- 004). The small rewards given in Contingency Management compete with the frequent rewards they are habituated to receive from the stimulants.
"The only current treatment for stimulant
use disorders with significant evidence of
effectiveness is Contingency Management" (SAMHSA)
Effectiveness in these types of programs is measured by looking at how many people are still off the stimulants 3 months after starting treatment. One study found about 35% of stimulant addicts were still successful in a conventional program at 12 weeks, compared to 49% of those in a Contingency Management program (The Psychiatrist, 35(5), 161–163.). For the very small cost of few trinkets and gift cards, a lot more people are able to accomplish the very important goal of overcoming their addiction.
Contingency Management has mainstream recognition and approval. The federal government, (U.S. Department of Health and Human Services) is sponsoring a training to provide an overview of Contingency Management later this month focused on:
"Key principles and implementation strategies of contingency management, including program effectiveness related to individuals with stimulant use disorders."
I received an invitation to attend and the training is free.
Of course there is always some controversy about everything, and sure enough, some people complain that we should not be bribing people to do what they should be doing anyway. And "Who pays for the prizes anyway", they ask. "Is our tax money paying for this?" Based on these types of concerns limits have been established on the total allowed value of the rewards. CMS (Medicare and Medicaid) limits the total cash value to $75 a year and Washington state, where I am located has set $100 as the annual limit. However, California just started a pilot program that may give up to $599 in 6 months. So the total allowed cash value ranges from a couple of dollars a week here in Washington, up to around $20 a week in California's trial regimen.
Of course, as you probably suspect, bigger rewards are believed to work better than smaller rewards. So it will be exciting to see how successful the program is in California with the higher limit.
Whether the annual limit is $100 or $500, the amazing thing to me is that the rewards make such a huge impact. These are human lives we are talking about, and stimulant addiction, like most drug addictions, is ultimately fatal. To think that we can save 50% more people from an addiction that is ultimately fatal, is a fantastic thing in my opinion.
If you do not suffer from stimulant addiction, you may have a friend, family member or co-worker that does. Urge them to get into treatment! If they have tried treatment and failed or relapsed, they should try again. Remember, anyone can call 988 for any mental health crisis, which includes addiction issues.
Contingency Management, can be a huge help to our friends with stimulant addictions!
And that my friends, is good news indeed!
Take care and BE HEALTHY!
CW Jasper
September, 2022