Dr Nicola Metrebian

Dr Nicola Metrebian is a Senior Research Fellow in Addictions at King’s College London. She has 20 years in addiction research undertaking large clinical RCTS to assess the effectiveness of pharmacological and behavioural interventions for opiate users. Her research has included evaluating supervised heroin treatment for hard to treat heroin users (RIOTT), assessing the effectiveness of contingency management (positive reinforcement using financial incentives) in encouraging the completion of hepatitis B vaccination and in improving treatment outcomes for opiate users receiving opiate substitution treatment. She is currently researching the use of mobile telephones to deliver behavioural interventions.

Use of contingency management (positive reinforcement with financial incentives) to encourage abstinence from heroin (PRAISE): a UK cluster randomised trial

Presentation link: pending.

Aims: Contingency management (CM) is a behavioural intervention based on the principles of operant conditioning; it uses positive reinforcement to encourage behaviour change. There is an evidence base for its effectiveness but mainly from the US. There has been little research on CM in the UK. This trial aimed to assess whether CM is effective at promoting abstinence from heroin among individuals receiving opiate substitution treatment (OST).

Methods: A cluster randomised controlled trial was conducted at 34 sites in England to assess the effectiveness of CM (using modest financial incentives) – targeted at (a) abstinence from heroin or (b) attendance at keywork sessions. Sites delivered OST and 12 weekly keywork sessions and were randomly allocated to deliver (a) CM Abstinence – reinforcement for attending keywork sessions on time and providing opiate-negative urine samples; (b) CM Attendance – reinforcement for attending keywork sessions on time only; or (c) no CM. Participants in each site received the same assigned treatment. The primary outcome was number of heroin-negative urine samples between weeks 9-12. Follow-up was undertaken at 12 weeks after cessation of CM.

Results: Participants who received (b) CM Attendance were twice as likely to provide heroin-negative urine samples during weeks 9-12 compared to (c) no CM (with a statistically significance difference). No statistically significant difference was found for (a) CM Abstinence compared with (c) No CM. Benefits were not sustained at 21-24 weeks.

Conclusions: Findings from the extended follow-up and embedded process evaluation will also be presented. Clinical and policy implications will be discussed.