Abstract

Objective

This multicenter, parallel randomized, open study examined the effect of using vouchers and session reminders as an added element to outpatient treatment for drug use disorders in youth. It was hypothesized that being randomly assigned to a contingency management condition would lead to a reduction of psychiatric symptoms, and that this reduction would be mediated through abstinence and treatment completion.

Methods

A total of 460 participants aged 15 to 25 years from nine outpatient sites were randomized to one of four treatment conditions (standard treatment alone [STD], i.e., 12 sessions using motivational interviewing and cognitive behavioral therapy, STD plus vouchers for attendance [VOU], STD plus text reminders [REM], or STD plus vouchers and text reminders [REM + VOU]). Participants’ symptoms of psychological distress were assessed using the YouthMap 12 instrument at intake, and at 3, 6, and 9 months post-treatment initiation. Interviewers were blinded to interventions.

Results

114 participants were randomized to STD, 112 to REM, 113 to VOU, and 121 to VOU + REM. 69 clients were never interviewed for follow-up, leaving 391 for analysis (n = 90, n = 94, n = 99, n = 108). The mean age was 20.5 years (SD = 2.6), 23% were female, and 34% reported having a psychiatric diagnosis. Random effects regression showed that participants randomized to one of the two voucher-based conditions experienced significantly steeper declines in symptoms compared with STD (p < .01). Structural equation modeling results indicated that the effects of contingency management on symptoms were mediated through abstinence, but not sessions attended.

Conclusions

Adding contingency management to interventions for drug use disorders can reduce symptoms of psychological and emotional distress among populations of treatment-seeking youth, in part due to indirect effects through abstinence at follow-up. The data is collected from a clinical trial registered as ISRCTN27473213, at https://www.isrctn.com/.

中文翻译：

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凭证强化可减少青少年吸毒障碍治疗的精神症状——随机对照试验的事后二次分析

摘要

客观的

这项多中心、平行随机、开放式研究检查了使用代金券和会议提醒作为青少年吸毒障碍门诊治疗的附加元素的效果。假设被随机分配到应急管理条件会导致精神症状的减少，并且这种减少将通过禁欲和治疗完成来介导。

方法

来自 9 个门诊点的 460 名 15 至 25 岁的参与者被随机分配到四种治疗条件之一（单独标准治疗 [STD]，即使用动机访谈和认知行为疗法进行 12 次治疗，STD 加上出席券 [VOU] 、STD 加文本提醒 [REM]，或 STD 加代金券和文本提醒 [REM + VOU]）。参与者的心理困扰症状在摄入时以及治疗开始后 3、6 和 9 个月时使用 YouthMap 12 仪器进行评估。采访者对干预措施视而不见。

结果

114 名参与者被随机分配到 STD，112 名参与者被随机分配到 REM，113 名参与者被随机分配到 VOU，121 名参与者被随机分配到 VOU + REM。69 名客户从未接受过随访，剩下 391 名进行分析（n  = 90，n  = 94，n  = 99，n  = 108）。平均年龄为 20.5 岁 ( SD  = 2.6)，23% 为女性，34% 报告有精神病诊断。随机效应回归显示，与 STD 相比，随机分配到两种基于凭证的条件之一的参与者的症状下降幅度更大（p  < .01）。结构方程建模结果表明，应急管理对症状的影响是通过禁欲来调节的，但不是参加会议。

结论

在药物使用障碍干预措施中增加应急管理可以减少寻求治疗的青年人群的心理和情绪困扰症状，部分原因是在随访中戒断产生的间接影响。数据来自注册为 ISRCTN27473213 的临床试验，网址为 https://www.isrctn.com/。