Developing a UK Evidence Base for Contingency Management in Addiction Treatment: Adjunctive Incentive-based interventions to improve treatments to reduce drug use and associated harms

Aims & Objectives:• To evaluate the feasibility, acceptability and clinical and cost-effectiveness of contingency management (CM) interventions in NHS drug treatment settings designed to (a) promote take-up of harm reduction interventions and (b) retain opiate dependent clients in treatment and reduce their use of street drugs.• To describe treatment process and assess the feasibility and acceptability of CM interventions from clinician and service user perspectives and to use evidence thus generated to develop, deliver and evaluate staff training which supports the introduction of CM.Background: Effective treatments for drug dependence now exist (eg opiate substitution treatment) but do not produce the full patient or public benefit because of high levels of progressive drop-out. Adjunctive contingency management (CM) interventions have recently been developed to amplify patient benefit by provision of positive reinforcement of desired change in behaviour (e.g. rewarding medication compliance, or abstinence from street drugs). CM has a strong evidence base from US trials and has recently been recommended by NICE for UK implementation [Pilling et al, 2007]. However, the UK has no track record of applying CM in drug treatment settings. Also, it is unclear whether this benefit derives from a direct effect of CM on the selected target behaviour or is a general benefit resulting from CM-stimulated improved retention in treatment. Hence, there is an urgent need to generate evidence about the feasibility, acceptability and clinical and cost-effectiveness of different possible CM interventions applied in NHS drug treatment settings.Research Team: We are a multi-disciplinary team whose members represent NHS management, psychiatry, psychology, medical sociology, statistics & health economics. All have proven track records in collaborative and applied health services research in NHS settings. The lead applicant is Director of the National Addiction Centre (NAC) - Europe’s highest rated addictions research centre. The work of the core team will be supplemented by expertise in CM from the USA (Prof. Nancy Petry) and medical ethics (Prof. Richard Ashcroft). Research Environment: The research programme will be led by the South London & Maudsley (SLaM) Trust but will be managed as a collaborative venture by investigators based at three London NHS trusts. These are SLaM, together with Central & North West London MHT (CNWL), Camden & Islington (C&I) Trust. The programme will also involve research partners in Birmingham and Leeds. SLaM, CNWL and Leeds are all ‘3 star’ Trusts in the first wave of Mental Health Trusts to achieve Foundation Trust status. All trusts have close links with the Mental Health Research Network and have a tardition of successful collaboration with University partners.Programme Outputs:• Introduction of CM into NHS addiction treatment settings. • Generalisable evidence about patient benefit and costs from year 2. • Evidence about organisational and professional factors that affect the implementation of CM in the NHS.• New CM training modules and materials.• Information about treatment process and good practice that will enhance CM implementation generally across the NHS. • Funding proposals for definitive RCTs submitted within the programme timetable.Public InvolvementThrough collaboration with Peter McDermott (user advocate and policy officer) and colleagues at The Alliance (National Drug User Group) and with the NTA, we will establish a Service User Advisory Group – a mechanism successfully used in the development of the Department of Health ‘Drug Misuse and Dependence: UK Guidelines on Clinical Management’. Annette Dale Perera, NTA Director of Quality, will be involved as a collaborator. The NTAs involvement demonstrates strong support for the programme from those directly responsible for Government National Drug Strategy and will be invaluable for implementation of findings