Telephone-delivered contingency management to promote behaviour change in addiction treatment.

Background: Contingency Management (CM) interventions (positive reinforcement to encourage behaviour change) have gained considerable interest in the treatment of addiction. However, they require frequent monitoring of behaviour change and differential delivery of incentives making their implementation resource intensive and burdensome for clinical staff. CM delivered by technology might offer a low-cost alternative, allowing greater accessibility to services; remote therapeutic contact and monitoring of behaviour; minimise issues of staffing and resources; and allow for services to stay in contact with patients over a longer period to support recovery.

Recent research evidence suggests that mobile telephone-delivered CM may be effective in promoting health related behaviours including smoking cessation and abstinence from alcohol. However, little is known about the key mechanisms involved in determining how it may work and when and for whom; or whether it is feasible to implement or acceptable to staff and service users in UK addiction services. To address these questions, a mixed methods study is being carried out to investigate if CM interventions can be delivered by mobile telephone to promote behaviour change by assessing the evidence for its effectiveness and its feasibility and acceptability among addiction service users and staff.

Methods: A systematic review and meta-analysis sought to assess the effectiveness of telephone-delivered CM to promote abstinence and treatment adherence among individuals receiving substance use treatment.

A process evaluation will enable exploration of how telephone-delivered CM is being implemented in a UK addiction service setting. Semi-structured interviews with 20 patients at a London drug clinic receiving telephone-delivered CM as part of a trial will be conducted. Clinic staff involved in the intervention will also be interviewed. Interviews will allow for exploration of contextual factors that might influence intervention implementation and the causal mechanisms that promote behaviour change in non-face-to-face interventions. Interviews will also explore the concept of therapeutic alliance and aid the development of a tool to measure the strength of this relationship. Interviews are audio-recorded, transcribed verbatim and subjected to a thematic analysis.

Results: Our systematic review and random effects meta-analyses found telephone-delivered CM conditions to yield better outcomes compared to treatment as usual conditions across a number of outcomes when targeting substance use; Percentage of Negative Samples (PNS), Longest Duration Abstinence (LDA) and Quit rate (QR).

Participants experiences and attitudes towards CM (receiving verbal praise and financial incentives) and receiving it remotely will also be presented. Reflecting on the key themes including history of drug use, previous attempts in recovery, experience of methadone maintenance programmes, acceptance of the CM intervention delivered by telephone and the strength of any therapeutic relationship in non-face-to-face interventions will be presented.

Conclusion:

Promising, but limited evidence base for telephone-delivered CM suggests the need for future research. Understanding how these interventions might promote behaviour change and capturing patient’s experiences and willingness to receive CM delivered remotely will help our understanding of how these interventions might work and who is most likely to benefit from them.