April 5, 2010

Can an incentive program help drug users with mental issues?

Innovative strategy may improve treatment of people with drug habits that also suffer from mental disorder

Men and women trying to shake their drug habits while also dealing with mental disorders pose difficult challenges for medical providers and health care policy-makers. And while combining psychiatric and addiction treatment services at one location holds great promise, this model has so far proved disappointing.

What often happens is that patients show up to receive their medications at addiction treatment centers, but they don’t stay around for the psychiatric programs. This leads to poor outcomes and far greater costs.

Now, Michael S. Kidorf of Johns Hopkins is using a $445,000 ARRA Challenge Grant from the National Institutes of Health to evaluate an innovative incentive strategy for improving treatment outcomes.

“There are two ideas here,” said Kidorf, an associate professor in the School of Medicine’s Department of Psychiatry and Behavioral Sciences. “We want to find out if behavioral reinforcement leads to increased adherence to psychiatric care; and second, will adherence to psychiatric care lead to improved outcomes?”

A previous NIH-supported study by Kidorf and Robert Brooner, director of Addiction Treatment Services at Johns Hopkins Bayview Medical Center, was the first controlled and randomized evaluation of a delivery model combining methadone treatment and psychiatric services. But too many patients dropped out of treatment or didn’t show up for the psychiatric programs, so the results were skewed.

“We’ve found that it’s not simply enough to offer patients convenient treatments in one location to have an impact,” Kidorf noted.

So this time, his research team is randomly assigning drug-dependent patients to one of two groups of 42 men and women. The first group will receive the full range of psychiatric and drug treatment services. The second will have access to the identical program with one difference: a $25 voucher each week. To earn that monetary incentive, patients must meet weekly with a psychiatrist, talk with a mental health counselor and attend group-counseling sessions.

These vouchers accumulate in an account, and patients can draw on them for needed goods and services, which are purchased for them by the research team.

“We will measure if patients with vouchers go to scheduled sessions and whether there are positive changes in their psychiatric and drug symptoms,” Kidorf said.

The ARRA Challenge Grant enabled Kidorf, who is also associate director of Addiction Treatment Services at Bayview, to create three new research jobs and retain two existing positions.

Progress within the two study groups will be assessed and compared after three months. The entire study, including a report at a national meeting, will be completed within ARRA’s two-year timetable.

“This could lead to a lot of other good things,” said Kidorf, pointing out such possibilities as more effective and shorter psychiatric treatment, cost savings, improved monitoring of and adherence to drug regimens, and better patient outcomes.

Kidorf’s team’s investigations are among the 380 stimulus-funded research grants and supplements totaling $192 million that Johns Hopkins has garnered since Congress passed the American Recovery and Reinvestment Act of 2009 (informally known by the acronym ARRA), bestowing the National Institutes of Health and the National Science Foundation with $12.4 billion in extra money to underwrite research grants by September 2010. The stimulus package—which provided $550 billion in new spending, including the above grant—is part of the federal government’s attempt to bring back a stumbling economy by distributing dollars for transportation projects, infrastructure building, the development of new energy sources and job creation, and financing research that will benefit humankind.

Johns Hopkins scientists have submitted about 1,300 proposals for stimulus-funded investigations, ranging from strategies to help recovering addicts stay sober and the role that certain proteins play in the development of muscular dystrophy to mouse studies seeking to understand how men and women differ in their response to the influenza virus.

As of March 15, 120 staff jobs have been created at Johns Hopkins directly from ARRA funding, not counting jobs saved when other grants ran out, and not counting faculty and grad student positions supported by the ARRA grants.