Voucher Reinforcement Decreases Psychiatric Symptoms in Young People in Treatment for Drug Use Disorders - A Post Hoc Secondary Analysis of a Randomized Controlled Trial.

IF 1.5 4区医学 Q3 PSYCHIATRY

Journal of Dual Diagnosis Pub Date : 2021-07-01 Epub Date: 2021-07-21 DOI:10.1080/15504263.2021.1942379

Morten Hesse, Birgitte Thylstrup, Sidsel Karsberg, Michael Mulbjerg Pedersen, Mads Uffe Pedersen

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引用次数: 2

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/.

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加强代金券可以减少年轻人在药物使用障碍治疗中的精神症状——一项随机对照试验的事后分析。

目的:这项多中心、平行、随机、开放的研究考察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一个附加因素的效果。假设被随机分配到一个应急管理条件会导致精神症状的减少，这种减少将通过戒断和治疗完成来调解。方法:将来自9个门诊站点的460名年龄在15 - 25岁的参与者随机分为4种治疗条件(单独标准治疗[STD]，即使用动机访谈和认知行为疗法的12次治疗，性病加就诊券[VOU]，性病加文本提醒[REM]，或性病加凭单和文本提醒[REM + VOU])。在治疗开始后的3个月、6个月和9个月，使用YouthMap 12工具评估参与者的心理困扰症状。采访者对干预措施一无所知。结果:STD组114例，REM组112例，VOU组113例，VOU + REM组121例。69名患者未进行随访，留下391名患者进行分析(n = 90, n = 94, n = 99, n = 108)。平均年龄为20.5岁(SD = 2.6)， 23%为女性，34%报告有精神诊断。随机效应回归显示，与性病相比，随机分配到两种基于凭证的条件之一的参与者的症状明显下降(p)。结论:在药物使用障碍干预措施中加入应急管理可以减轻寻求治疗的青少年群体的心理和情绪困扰症状，部分原因是通过随访时的禁欲产生的间接影响。数据收集自注册为ISRCTN27473213的临床试验，网址为https://www.isrctn.com/。

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来源期刊

Journal of Dual Diagnosis Multiple-

CiteScore

4.90

自引率

13.60%

发文量

期刊介绍： Journal of Dual Diagnosis is a quarterly, international publication that focuses on the full spectrum of complexities regarding dual diagnosis. The co-occurrence of mental health and substance use disorders, or “dual diagnosis,” is one of the quintessential issues in behavioral health. Why do such high rates of co-occurrence exist? What does it tell us about risk profiles? How do these linked disorders affect people, their families, and the communities in which they live? What are the natural paths to recovery? What specific treatments are most helpful and how can new ones be developed? How can we enhance the implementation of evidence-based practices at clinical, administrative, and policy levels? How can we help clients to learn active recovery skills and adopt needed supports, clinicians to master new interventions, programs to implement effective services, and communities to foster healthy adjustment? The Journal addresses each of these perplexing challenges.