Learning Objective #1: Identify psychosocial and substance abuse differences in patients who present for substance abuse treatment for the first time versus patients with multiple treatment episodes

Learning Objective #2: Recognize subgroups of patients who are more likely to benefit from adding an innovative motivational incentive program to treatment as usual in community treatment programs

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Purpose: To determine if prize based motivational incentives will improve substance abuse outcomes in patients with multiple treatment episodes versus patients entering treatment for the first time. Design and Population: 415 treatment seeking outpatients with self report of stimulant use in the past 14 days were randomized to receive either prize-based incentives plus treatment as usual (TAU) or TAU alone. All patients submitted twice weekly urine drug screen for 12 weeks. Participants were divided into two treatment history groups, multiple treatment episodes, defined as 2 or more past treatment episodes (N = 150) and treatment naïve, defined as first treatment episode (N=260). Outcome variables included longest sustained period of stimulant abstinence and retention in treatment. Method: Baseline differences between the two treatment history groups were analyzed using Pearson-Chi Square analysis and independent t tests. GLM univariate analysis of variance with study group, baseline urine drug screen and treatment history entered as fixed independent variables was used to predict the outcome variables. Findings: There were no between group differences for participants in both treatment history group regardless of being in the incentive or control group with regard to the outcome variables. There was an interaction between treatment history and baseline urine drug screen on the primary outcome variables. Participants with multiple treatment episodes and a negative baseline stimulant urine sample had 9.43 ± 9.3 consecutive stimulant free urine samples versus 2.3 ± 5.3 for those with positive baseline stimulant samples and longer retention in treatment (8.5 ± 3.7 weeks versus 4.3 ± 4.3 weeks, F, 15.47, p = 0.001). Implications: Patients with multiple treatment histories respond with similar outcomes as treatment naïve patients to a motivational incentive intervention adjunctive to TAU. Patients with multiple treatment episodes have a more robust response if they have stopped using at the initiation of treatment.