Contingency management reduces symptoms of psychological and emotional distress among homeless, substance-dependent men who have sex with men

Abstract

This prospective analysis evaluated the efficacy of a contingency management (CM) intervention to improve the psychological health of non-treatment seeking, homeless, substance-dependent men who have sex with men (MSM) in Los Angeles. It was hypothesized that the administration of CM would be associated with reductions in participants' symptoms of psychological and emotional distress. One hundred and thirty-one participants were randomized into either a voucher-based CM (n = 64) condition reinforcing substance abstinence and prosocial/health-promoting behaviors, or to a control condition (n = 67). Participants' symptoms of psychological and emotional distress were assessed at intake and at 12-months post-randomization. Participants randomized into the CM intervention exhibited significantly lower levels of psychological distress in all measured symptom domains up to one year post-randomization, reductions not evidenced in the control arm. Omnibus tests resultant from seemingly unrelated regression analysis confirmed that CM was significantly associated with reductions in symptoms of psychological and emotional distress, even when controlling for biomarker-confirmed substance-use outcomes (; p < 0.05). Findings demonstrate that a CM intervention reduced symptoms of psychological and emotional distress among a sample of non-treatment seeking, homeless, substance-dependent MSM.

Keywords:

• contingency management
• homeless
• dual diagnosis
• substance use
• MSM
• psychological distress

Acknowledgements

The National Institute on Drug Abuse (NIDA), the Los Angeles County Division of HIV/STD Programs (DHSP; formerly Office of AIDS Programs and Policy), and/or the National Institute of Mental Health (NIMH) had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report or in the decision to submit the paper for publication.

Funding

Funding for this study was provided by the NIDA [grant number RO1 DA015990]. Funding for the HIV prevention program was provided by DHSP Contract H-700861. Cathy J. Reback and Steven Shoptaw acknowledge additional support from the NIMH Grant P30 MH58107.