Treatment for Psychological and Drug Abuse Problems

Johns Hopkins University

Status: Completed

Conditions: Substance Use Disorders

Treatments: Behavioral: Standard Control; Behavioral: Voucher Reinforcement

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01140334

1RC1DA028154-01

Details and patient eligibility

About

The purpose of the study is to evaluate methods to help people in substance abuse treatment receive better psychiatric care. Patients enrolled in the study will be offered three months of standard psychiatric treatment, which consists of weekly individual counseling and group counseling, as well as regular appointments with a psychiatrist. Patients will be randomly assigned to standard psychiatric care or standard psychiatric care plus voucher incentives. These incentives can be earned by successfully attending all scheduled psychiatric appointments each week. The investigators expect that patients in the voucher condition will attend more psychiatric sessions, which will lead to greater reductions in psychiatric distress.

Full description

Male and female opioid-dependent patients at Addiction Treatment Services with any current psychiatric disorder (N = 100) will be randomly assigned to one of two psychiatric service conditions: 1) reinforced on-site integrated care (ROIC), with voucher incentives contingent on attending weekly psychiatric sessions; or 2) standard on-site integrated care (SOIC). Participants in both conditions will receive access to the same schedule and range of psychiatric and substance abuse treatment services. Participants will be assessed for 3-months post-randomization to determine rates of service utilization and adherence to psychiatric care, changes in scope and severity of psychiatric and psychosocial problems, and rates of drug use and treatment retention. Positive findings would have considerable heuristic and health care policy and practice implications. The entire study, including dissemination of the major findings at a national meeting and submission of the first manuscript, is designed to be completed within 2-years.

Enrollment: 158 patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• At least 18 years of age
• Voluntarily seeking psychiatric treatment
• Meets DSM-IV criteria for opiate dependence
• Meets FDA/CSAT guidelines for methadone maintenance
• Meets DSM-IV criteria for at least one current psychiatric disorder

Exclusion criteria

• Pregnancy
• Onset or acute exacerbation of a medical illness requiring immediate and intense care
• An organic mental disorder (e.g., delirium, dementia)
• Current participation in psychiatric care
• Mandatory psychiatric treatment

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

158 participants in 2 patient groups

Reinforced On-Site Integrated Care (ROIC)

Experimental group

Description:

Patients assigned to this condition will be treated at ATS for psychological problems. They will be scheduled to participate in individual therapy sessions with a psychiatrist and with their substance abuse counselor. They will also be referred to attend group therapy one time per week. In addition, they will be able to earn a voucher incentive for each week of psychiatric compliance.

Treatment:

Behavioral: Voucher Reinforcement

Standard On-Site Integrated Care (SOIC).

Active Comparator group

Description:

Patients assigned to this condition will be treated at ATS for psychological problems. They will be scheduled to participate in individual therapy sessions with a psychiatrist and with their substance abuse counselor. They will also be referred to attend group therapy one time per week.

Treatment:

Behavioral: Standard Control