13 May Contingency Management Helps Recovering Heroin Users Avoid Hepatitis B
Hepatitis B is a viral infection that can cause potentially life-threatening damage to the liver. Intravenous (IV) drug use is one of the known risk factors for developing this infection. An effective vaccine for hepatitis B exists, but recovering IV drug users often fail to complete the vaccination process while participating in addiction treatment. In a study published in April 2014 in the journal The Lancet, researchers from several British institutions assessed the effectiveness of a form of behavioral therapy called contingency management in improving the hepatitis B vaccination rate among recovering heroin addicts.
Doctors use the term hepatitis to refer to inflammation in liver tissue. Hepatitis B is a form of liver inflammation caused by the infectious hepatitis B virus, or HBV. Some people affected by this virus develop symptoms right away, while others may experience no effects for as long as half a year. When symptoms do arise, they can vary in intensity from mild to severe and include such things as a low-grade fever, a declining appetite, joint and muscle pain, nausea, vomiting, jaundice, declining energy levels and urine with an abnormally dark color. In most cases, these problems will resolve in time as the body marshals its defenses. However, some people fail to fight off the virus and develop a chronic, ongoing form of hepatitis B. Potential major consequences of this chronic infection include cirrhosis (liver scarring), infection with another strain of hepatitis virus called hepatitis D, kidney failure, liver failure and liver cancer.
There is currently no available medical option that will cure people infected with hepatitis B. However, a multi-part vaccination process can prevent infection in individuals who later get exposed to the virus. In addition to people who share needles while using IV drugs, groups at-risk for exposure to HBV include people who have sex with multiple partners without using condoms, people infected with a sexually transmitted disease, people receiving a treatment for advanced kidney disease called hemodialysis and people who work in a profession that requires the handling of human blood.
The goal of contingency management is to encourage people recovering from the use of certain substances of abuse to follow the guidelines of their treatment programs and take the steps necessary to meet the periodic milestones that mark progress in the recovery process. In order to achieve this goal, contingency management practitioners use vouchers or cash as incentives to motivate program participants. As a rule, the rewards issued in voucher-based and cash-based programs increase as any given individual meets more and more of his or her goals. Contingency management has been successfully used to treat people affected by addictions to opioid drugs or medications, stimulant drugs or medications, marijuana, alcohol and nicotine.
Usefulness in Hepatitis B Vaccination
In the study published in The Lancet, researchers from Imperial College London, University College London, King’s College London and the NHS Foundation Trust used an examination of 210 recovering heroin addicts to assess the effectiveness of contingency management in improving the completion rate for hepatitis B vaccination among people receiving treatment for IV drug use or any other form of injection drug use. These researchers undertook their project, in part, because recovering injection drug users commonly fail to complete the multi-step hepatitis B vaccination process, and therefore remain vulnerable to the hepatitis B virus.
One-third of the study participants received a voucher worth roughly $20 as an incentive for completing each of the three phases of vaccination. Another third of the participants received vouchers that gradually escalated in value from roughly $10 to $30 for completion of each step in the vaccination process. The remaining participants did not receive a voucher incentive for completing hepatitis B vaccination. Only 9 percent of the recovering addicts who did not receive an incentive completed the vaccination process. In contrast, the completion rates for the recovering addicts who received fixed-value vouchers and increasing-value vouchers were 45 percent and 49 percent, respectively. The researchers concluded that the differences in these outcomes were statistically significant.
The main treatment received by the participants in the study published in The Lancet was opioid substitution therapy, an approach that uses opioid medications (buprenorphine or methadone) as short- or long-term replacements for opioid substances of abuse. The study’s authors concluded that contingency management can help individuals receiving this form of treatment complete hepatitis B vaccination, even when the rewards provided as incentives remain quite small. In line with this conclusion, they recommend the use of contingency management to achieve vaccination goals during the recovery process.
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