ADAM Newsletter-September 2016

Autumn Newsletter  

ADAM Trial Pilot

With the change in season marks the beginning of the end of the pilot phase of the ADAM trial. Recruitment has offcially begun across the five study sites, with all sites successfully recruiting their first participant. Thank you to all the clinical teams for their referrals and ongoing support.

Recruitment update

We are pleased to report we currently have thirty-one participants recruited across all five sites and have begun to complete the first two-month follow-ups.

Our Birmingham site is steaming ahead with eleven participants successfully recruited. Researchers from all sites have been working hard with clinical teams to identify suitable participants. We will continue to work to reach our target of eleven participants per site per month.

The recruitment push will continue as we look to complete the pilot phase this autumn. Thank you for all the referrals so far and to all participants who have signed up!

A warm welcome to Maria-Leoni Koutsou!

She is the new research assistant based in Birmingham.

 

Delivering relapse prevention medication training to primary care

Following the identification of training needs in primary care services by Central North West London (CNWL) alcohol services, the research team  organised a training session, ‘Alcohol Dependence and Relapse Prevention Medication in Primary Care’ to provide an opportunity to build links between primary and secondary care services.

This training and networking event had over thirty GPs, practice nurses, pharmacists, consultant psychiatrists and recovery workers from across the eight boroughs in CNWL come together. The training session was delivered by Professor Anne Lingford-Hughes from Imperial College London. She shared her breadth of clinical experience and academic knowledge with the room. The session raised awareness of alcohol related harm and developed skills and knowledge to manage alcohol related problems in primary care.

The ADAM team are committed to building links between primary and secondary care to improve patient care and treatment pathways. The feedback from the event has been overwhelming positive. Special thanks to Ealing CCG and Alcohol Research UK for their support in organizing this event.

cnwl-training-event

 

Who is your local research assistant?

Maria-Leoni Koutsou, Birmingham Research Assistant, Maria-Leoni.Koutsou@bsmhft.nhs.uk

Kate Shirvell, Southampton Research Assistant, K.Shirvell@soton.ac.uk

Rachel Simpson, Yorkshire and Humber Research Assistant, Rachel.simpson9@nhs.net

Kideshini Widyaratna, South London and Maudsley and Central North West London Researcher, Kideshini.widyaratna@kcl.ac.uk

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Contingency management in addiction research

What is Contingency management?

Contingency management is a treatment strategy that aims to increase motivation and encourage positive behaviours. It’s based on the simple behavioural principle that if a behaviour is rewarded it is more likely to be repeated. In psychology this is known as operant conditioning.  This principle is used in everyday life.

Examples of contingency management in everyday life:

  • Parents use pocket money (incentive) to encourage children to tidy their bedrooms (positive behaviour)
  • Employers use salaries and bonuses (incentive) to reward high performance and hitting targets (positive behaviour)

 

Contingency management as an intervention in addiction treatment

In addiction treatment contingency management can be used to encourage and reward behaviours that are consistent with a drug free lifestyle. Rewards are often in the form of vouchers or gift cards that can be exchanged for goods and services that are also compatible with a drug free way of life.

 

Contingency management as an intervention in addiction treatment

Examples of contingency management in addictions treatment:

  • Service users are rewarded for providing urine specimens that test negative for drugs, encouraging abstinence.
  • Service users are rewarded for attending clinic appointments, encouraging engagement with treatment

 

Contingency management in addiction treatment – is it controversial?

There is a controversy surrounding the use of contingency management in addictions services. One of the main concerns is that the financial incentives given to service users could be used to buy drugs. Another concern is that by encouraging behaviour change with external rewards the participants’ internal motivation could be reduced, which could lead to problems with motivation in the long term. Contingency management has also been criticised because it not only costs a lot with regards to the incentives given but also with regards to the amount of time it takes for it to be administered. However there is scientific evidence to suggest that contingency management is worth the investment.

Contingency management and addictions research – The ADAM trial

Research studies have previously demonstrated that incentive-based treatments are successful in motivating people to remain abstinent from drugs and remain in treatment. These research studies have been carried out with a variety of drugs including stimulants, opioids, marijuana, nicotine and alcohol.

RD CM

One aim of the ADAM Trial is to find out whether contingency management is successful at encouraging participants to engage with the telephone support provided by the pharmacist. Participants who are randomised to receive both the telephone support and the incentive, which is called the personal achievement award, will be rewarded with a £5 Love2Shop voucher for each of the 12 telephone call they complete over the 6 months of the study. In addition to this participants will be rewarded with a bonus each time they complete four calls in a row. A total of £120 can be earned for completing all support sessions and these vouchers can be spent in a range of places including high street stores, supermarkets (excluding cigarettes and alcohol) and on days out.

 

Personal achievement award

Sessions completed Incentive Bonus Running total
1 £5 £5
2 £5 £10
3 £5 £15
4 £5 £10 £30
5 £5 £35
6 £5 £40
7 £5 £45
8 £5 £20 £70
9 £5 £75
10 £5 £80
11 £5 £85
12 £5 £30 £120
Total £60 £60 £120

 

By carrying out this research we are able to learn about how effective the personal achievement award is at increasing engagement with telephone based support for alcohol dependence.

If you are taking part in the ADAM Trial and would like more information about where you can spend your Love2Shop vouchers, please click here https://www.highstreetvouchers.com/gift/where-to-spend-love2shop-cards

References

Cameron, J., & Ritter, A. (2007). Contingency management: perspectives of Australian service providers. Drug Alcohol Review, 26(2), 183-189.

National institute on drug abuse (2012). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine. Retrieved 18 August, 2016, from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-0

Petry, N. M. (2002). Contingency management in addiction treatment. Retrieved 18 August, 2016, from http://www.psychiatrictimes.com/addiction/contingency-management-addiction-treatment-0/page/0/1

Petry, N. M. (2010). Contingency management treatments: Controversies and challenges. Addiction, 105(9), 1507-1509

Petry, N. M. (2000) A comprehensive guide to the application of contingency management procedures in clinical settings. Drug Alcohol Dependence, 58(1-2), 9-25