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Heroin Addiction and Related Clinical Problems: 2006, 08, 2 (pages: 37 - 46)

A Low Value Voucher Contingency Management Programme with Israeli Methadone Maintained Patients – A Pilot Evaluation Study

Lawental E., Eshkol D.

Summary: Purpose: This study evaluated, for the first time, the effectiveness of a voucher-based contingency management programme (CMP) with a population of methadone-maintained patients outside the U.S.A. The study reported was carried out at the Haifa Drug Abuse Treatment Centre in Israel. The population studied differed culturally from previously studied groups in the U.S.A. Vouchers were given to patients upon providing a urine test that was negative for illicit drug use. With the accumulation of three consecutive vouchers subjects could redeem one for one take home dose. After the accumulation of five or more consecutive vouchers subjects were able to redeem two for two consecutive take-home doses. Method: Two groups of subjects were evaluated in this study. In the first group, subjects (n = 35) treated prior to the initiation of the CMP were included. These subjects provided 455 urine samples in the three months prior to the CMP. In the second group, subjects (n = 41) treated after initiation of the CMP were included. A three-month period was allowed for the Centre to adjust to the new CMP. Subjects in the “post” group provided 554 urine samples in the three months following this period. No statistically significant differences were noted between the groups with reference to their pre-treatment characteristics and the length of time subjects stayed in treatment. Results: The post CMP group showed an improvement in providing samples free of illicit substance abuse. An improvement of 36.3% was noted. The post group also had 47.1% more stable-on-methadone subjects. Conclusions: This study supports the claim that such a CMP may be effective in reducing illicit drug abuse in the Israeli methadone-maintained patient population. As the sample of this study is relatively small and no attempt was made to identify a specific group of Israeli patients that may benefit even more from this type or other types of CMP, additional studies are needed.