Decision-Making Tendencies and Voucher Spending Independently Support Abstinence Within Contingency Management for Methamphetamine Use Disorder

Decision-making tendencies and spending within cash voucher-based interventions have individually been shown to be related to future abstinence among participants with methamphetamine use disorder (MUD), but less is known of their independent contributions. This study of participants in a contingency management (CM) trial investigated whether decision-making and spending were each associated with future abstinence. Thirty-two outpatients with MUD, predominately male (68%) and mixed ancestry (94%) with a median age of 34 years, participated in an 8-week cash voucher-based CM pilot trial. Prior to commencing the trial, participants completed a computerized Iowa Gambling Task (IGT) to measure decision-making preferences for more frequent rewards and longer term gains of greater magnitude. Spending and abstinence of participants were tracked over the duration of the trial. In a secondary analysis, time-lagged counting process Cox Proportional Hazard models were conducted. Baseline decision-making, characterized by a preference for frequent rewards, was associated with a greater likelihood of future spending, Hazard Ratio; HR = 1.13 [1.06: 1.21]. Avoidance of short-term rewards to realize longer term, higher magnitude rewards, and spending at the prior visit were each associated with abstinence on the trial, HR = 1.12 [1.03: 1.22] and HR = 1.32 [1.08: 1.61], respectively. Controlling for decision-making, spending, and cumulative abstinence, prior abstinence remained the largest predictor of future abstinence, HR = 3.85 [2.88: 5.16]. Decision-making tendencies and spending are correlated yet independently associated with abstinence reinforcement in CM. Findings highlight the opportunity for behavioral treatment programs to tailor program structures to individual-specific characteristics. Public Health Significance Study findings highlight that decision-making tendencies and spending are independently associated with future abstinence in contingency management among individuals with methamphetamine use disorder.