15 Apr Does Contingency Management Work for People With a Dual Diagnosis?
Dual diagnosis is the term addiction specialists and mental health specialists use to identify people who have diagnosable problems with drugs or alcohol, as well as a separately diagnosable mental health condition. Typically, affected individuals are significantly more difficult to treat than people who only have substance-related problems or separate mental health issues. In a study published in August 2014 in the Journal of Dual Diagnosis, researchers from the University of Pittsburgh assessed the effectiveness of a behavioral therapy called contingency management in helping people affected by a dual diagnosis achieve improved outcomes in addiction treatment.
There is a two-way relationship between diagnosable substance problems and separately diagnosable mental health concerns, the National Alliance on Mental Illness reports. In some cases, people who have problems with drugs or alcohol ultimately develop symptoms of a mental illness such as a mood disorder (depression or bipolar disorder), an anxiety disorder or a schizophrenia-related disorder. In other cases, people diagnosed with a serious mental illness ultimately develop the symptoms of substance abuse or substance addiction (known collectively as substance use disorder). Current evidence indicates that approximately 33 percent of all Americans with a mental health diagnosis are involved in some form of substance abuse; the rate rises to roughly 50 percent for people with severe mental health problems. Conversely, at least 33 percent of all Americans who abuse alcohol have a diagnosable mental illness; the rate rises to more than 50 percent for people involved in drug abuse.
For several reasons, treatments that work well for individuals only affected by substance problems or only affected by mental illness may not produce the same benefits for individuals affected by a dual diagnosis. A primary reason is the reduced effectiveness of certain mental illness treatments in people with diagnosable abuse or addiction symptoms. Addiction specialists and mental health specialists may attempt to address any treatment concerns by doing such things as tackling the issue of substance abuse/addiction before tackling the issue of separate mental illness.
Contingency management is a behavioral technique that attempts to promote increased involvement in substance treatment programs by giving participants a tangible benefit for their continuing commitment to program goals and guidelines. In some cases, this tangible benefit is delivered in the form of vouchers that program participants can turn in for specific items or specific services. In other cases, the tangible benefit takes the form of an opportunity to win a small sum of cash in a regularly held drawing. Both of these approaches reward participants for doing such things as submitting substance-free urine samples and attending scheduled activities. Conversely, a person who fails to submit substance-free urine samples or attend scheduled activities may have his or her voucher privileges or cash drawing privileges revoked or reset back to a minimum baseline level.
Effectiveness in Dual Diagnosis Treatment
In the study published in the Journal of Dual Diagnosis, the University of Pittsburgh researchers tested the effectiveness of contingency management as a dual diagnosis treatment with the help of 160 people enrolled in a dual diagnosis program based on a mixture of hospitalization and outpatient treatment. Eighty-eight of the study participants received contingency management-based care for a period of six weeks, while the remaining 72 participants received care not based on contingency management. The two primary measurements used to gauge the benefits for both of these groups were the number of substance-abstinent days and the rate of attendance at five weekly treatment sessions.
The researchers concluded that the dual diagnosis patients involved in contingency management-based care attended scheduled treatment sessions more than 50 percent more often than the patients not involved in contingency management-based care. Both groups had a roughly equal number of substance-abstinent days. However, the researchers concluded that contingency management ultimately indirectly contributes to patients’ goals of substance abstinence by increasing the likelihood that they will stay active in their treatment programs over time.
Specific problems in both groups of study participants that reduced the ability to successfully refrain from substance use included persistent cravings for continued substance intake and difficulty dealing with the mental/emotional stress of their treatment. The study’s authors believe that effective steps to address these issues can significantly enhance treatment outcomes and contribute to the overall usefulness of contingency management in a dual diagnosis context.
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