contingency management

[mikey]

two things do not have to be written on the same page to be connected. Payments as a reward for abstention and directives to encourage joining an abstentionist group. When both these things arrive at the same time from the same source you can seperate the pages and place them at opposite ends of the universe and they will still remain linked.
Oh - I have read them by the way. Only I read them with open eyes.

[simon]

two things do not have to be written on the same page to be connected. Payments as a reward for abstention and directives to encourage joining an abstentionist group. When both these things arrive at the same time from the same source you can seperate the pages and place them at opposite ends of the universe and they will still remain linked.
Oh - I have read them by the way. Only I read them with open eyes.

Mikey,
can you point me to the 'Directive' that encourage joining abtentionist groups?

[mikey]

Here is a direct cut and paste job from NICE Clinical guidelines 51  page 7
The two paragraphs follow on one after the other strangely enough! Note the use of the word should in the first paragraph.
Could be me being paranoid but it looks suspiciously like a directive to me!


Self-help

Staff should routinely provide people who misuse drugs with information about self-help groups. These groups should normally be based on 12-step principles; for example, Narcotics Anonymous and Cocaine Anonymous.

Contingency management

Introducing contingency management
Drug services should introduce contingency management programmes – as part of the phased implementation programme led by the National Treatment Agency for Substance Misuse (NTA) – to reduce illicit drug use and/or promote engagement with services for people receiving methadone maintenance treatment.
A  link to it is here by the way….
http://www.nice.org.uk/nicemedia/pdf/word/CG51NICEGuideline.doc

Glad to help. Mikey.

[simon]

Here is a direct cut and paste job from NICE Clinical guidelines 51  page 7
The two paragraphs follow on one after the other strangely enough! Note the use of the word should in the first paragraph.
Could be me being paranoid but it looks suspiciously like a directive to me!


Self-help

Staff should routinely provide people who misuse drugs with information about self-help groups. These groups should normally be based on 12-step principles; for example, Narcotics Anonymous and Cocaine Anonymous.

Contingency management

Introducing contingency management
Drug services should introduce contingency management programmes – as part of the phased implementation programme led by the National Treatment Agency for Substance Misuse (NTA) – to reduce illicit drug use and/or promote engagement with services for people receiving methadone maintenance treatment.
A  link to it is here by the way….
http://www.nice.org.uk/nicemedia/pdf/word/CG51NICEGuideline.doc

Glad to help. Mikey.

Mikey,
In my mind should is not a directive MUST is. I think patients should be given opportunities to whatever might help them and we would be negligent not to do so. We have NICE guidelines that are based on a great deal of evidence to support contingency management and we are told we should implement them.
I am fully aware of the wording of the guidelines but you are interpreting them differently to what is intended - yes it might be your paranoia.

[Claire B]

Yes... SHOULD is a directive(approx 90 % adherence, and a reasoned case not to)... MUST(100% adherence and a good lawyer if not)... realising this has got me out of many a tight corner

[mcdermott]

Sorry, Claire. I don't know what I was thinking when I wrote that -- particularly as I was claiming exactly the opposite when I was training regarding NICE guidelines last week. In my defence, I was late and was dashing out the door. What I meant to say was that it's only a directive with regard to giving people information, which I don't think is unreasonable. As compared with Methadone maintenance treatment at optimum doses, which as a technology guideline is a treatment that *must* be available to patients in all areas.

I think it's particularly interesting when it comes to the new Orange Guidelines as the changes will inevitably be extremely challenging. As you say, there's an expectation of 90% compliance, with documentation of the reasons where different decisions are made. This is going to be very interesting when it comes to cases of people who are currently still being terminated for non-compliance, in direct contravention of the guidelines.

[mikey]

Thanx Claire

[mcdermott]

Okay Peter. If I accept what you say, then can you send me a link to where I can view this evidence for myself.

All of evidence is cited in the full copies of the guidelines. Any decent university library should be able to provide you with copies of any of the articles cited. They were all articles published in reputable peer reviewed journals.

But much of the strength of the NICE recommendations comes from the process of Meta-analysis, as I pointed out earlier. This means not looking at a single study, but aggregating the research data from all of the highest quality out there, and looking at trends on the basis of that best evidence aggregated. This process actually takes place in real time, with NICE's researchers running the various meta-analysis tools during meetings. I'm also pretty sure that it's not some secretive, private process. Any legitimate researcher working in the area could ask the team at NICE for their data set, or enter in the same data from the same studies in order to check their results. That's how good science -- the stuff that NICE as opposed to private firms like the tobacco industry --works. The data sets get made publicly available. There's a detailed account of the methodology. And it's all checked by people with similar expertise working in the same field.

And just to pre-empt any suggestion that they're all in it together, the exact opposite is true. Because an organization like NICE is so prestigious, a young researcher would gain a great deal of prestige and status if they were to find them guilty of somehow fudging the data or relying on dubious studies. Scholarly research is like a competitive sport, and you move up the league tables by toppling those who have more status than you do through arguing against their methods, their data or their findings. This gives researchers an incentive to stay honest and rigorous, and gives young, hungry researchers an incentive to rigorously scrutinize the work of those that might be seen as their elders and betters.

[mcdermott]

Sorry, Claire. I don't know what I was thinking when I wrote that

And now I notice that I didn't write it at all. It was Simon. Heh.

[simon]

Mikey,
I would imagine now that you have been clearly signposted to the information and I would imagine this subject is pretty much closed as far as I can see. If you cannot find the evidence with all this help and me posting the research that you wanted the only other thing I could do is pop around your house with my lap top personally look up each one for you.

[mikey]

Thnks for the offer Simon. But one single link posted on here would be even easier I think.

Thanks anyhow.

[mcdermott]

Thnks for the offer Simon. But one single link posted on here would be even easier I think.

Here are the references. Its pretty rare to find any journal articles in full online as most journals make money by selling online subscriptions, but any university library will be able to track them down for you:

References
Higgins ST, Badger GJ, Budney, AJ (2000) Initial abstinence and success in achieving longer term cocaine abstinence. Experimental and Clinical Psychopharmacology 8: 377–86.
Kellogg SH, Burns M, Coleman P, et al. (2005) Something of value: the introduction of contingency management interventions into the New York City Health and Hospital Addiction Treatment Service. Journal of Substance Abuse Treatment 28: 57–65.
Kirby KC, Benishek LA, Dugosh KL, et al. (2006) Substance abuse treatment providers’ beliefs and objections regarding contingency management: implications for dissemination. Drug and Alcohol Dependence 85: 19–27.
McGovern MP, Fox TS, Xie H, et al. (2004) A survey of clinical practices and readiness to adopt evidence-based practices: dissemination research in an addiction treatment system. Journal of Substance Abuse Treatment 26: 305–12.
McQuaid F, Bowden-Jones O, Weaver T (2007) Contingency management for substance misuse. British Journal of Psychiatry 190: 272.
Messina N, Farabee D, Rawson R (2003) Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions. Journal of Consulting and Clinical Psychology 71: 320–9.
Petry N (2006) Contingency management treatments. British Journal of Psychiatry 189: 97–8.
Ritter A, Cameron J (2007) Australian clinician attitudes towards contingency management: comparing down under with America. Drug and Alcohol Dependence 87: 312–5.

[mikey]

Sorry but those are not available to be looked at. All you get are other reports which refer to those you list. Never the actual thing for some strange reason.

It is getting a bit boring now though so unless you can provide actual links to the genuine first-hand sources I think it is better just to let it go and accept that they will never be seen by human eyes!

No more to be said really is there?

[admin]

Have you tried contacting a university library to help you get them?  As Peter says, journals make their money by subscriptions and thus don't tend to like it when their articles and studies turn up on the internet for free.  But university or copyright libraries pay for access to these articles and studies and therefore they will be able to get them for you to read whenever you like.  If anyone does cut and paste anything to here which is copyright to a journal that is subscription access only, I will remove it for legal reasons.  Please stop the pointless challenges to produce material which we can not reproduce on this site and which is readily available if you really want to see it.

[mikey]

Look Ursula I am happy to let the matter go because it seems pretty obvious that if these reports exist- as they probably really do-  they cannot actually be scrutinised by the likes of you and me. Your suggestion is welcome so thank you, however, it does not change the fact that an awful lot has been made of this so-called over-whelming evidence yet as it turns out no-one has really seen it have they? Otherwise the easiest thing in the world would have been to simply post a link to it. But, instead just look at all the bluster and effort which has gone in to avoid doing that. The reason why is inescapable now isn't it?

But methinks the point is proven and time to let go. M.