2013-1: Lifestyle Training for CIA clients, combined with contingency management (Call 2013-1)
CIA (Custodial Institutions Agency) clients on an ambulatory treatment plan (for instance from a forensic psychiatric outpatient clinic (for addictions)) with problematic substance abuse and/or comorbid psychiatric disorders, where substance abuse interferes with adequate treatment and/or increases the risk of recidivism (criminogenic factor).
The designed protocol
The CIA clients Lifestyle Training (CLT) is an intervention based on cognitive behavioural therapy (CTG); it has been proven effective in the treatment of substance abuse and criminal behaviour. However, in almost 50% of the individuals following this training, there was a relapse, so the CLT needed improvement. A newly available behavioural therapy method called contingency management (CM) is a behavioural therapy programme aimed at systematic contingency confirmation (with money or vouchers) of the predetermined target behaviour. A combination of CBT and CM was obvious to achieve greater effectiveness and has already proved successful in various areas. This project investigated the usefulness and applicability of this combination treatment (CLT + CM) within regular forensic care. In practice, the added value is that this additional method can lead to more treatment compliance, less substance abuse and, as a result, less recidivism.
Applicability and effects
The applicability and usefulness of the CLT+CM protocol have been assessed in two institutions: judicial addiction care institution JusTact (part of Tactus Verslavingszorg) and the forensic mental health institution (GGZ) De Waag (part of De Forensische Zorg Specialisten). The protocol was used in two combinations, i.e. combined with a group-oriented cognitive behavioural therapy intervention and combined with an individual cognitive behavioural therapy intervention. The protocol proved to be easy to implement. The participating clients and employees were satisfied with the CLT+CM combination treatment. Based on this first application of the methodology, the cautious conclusion can be drawn that contingency management appears to have an additional effect on abstinent behaviour of the primary problem substance. The effect of CM in terms of compliance with CBT treatment was assessed positively by the practitioners. It was estimated that CM has a moderately positive effect on therapy compliance. The effect of CM, in combination with the monitoring of substance abuse, in terms of abstinent behaviour, was also experienced as positive by the practitioners of both institutions. Both the positive affirmation of abstinent behaviour on changes in substance abuse and the substance control itself have a positive influence on the treatment, according to the practitioners.
To implement this protocol, practitioners must be trained in the use of the CLT+CM protocol (course duration: 1 daily period/ 4 hours). Also, the practitioners recommend that the staff member applying the treatment is supervised for at least 4 hours, focusing both on the implementation of the CLT+CM protocol and the application of the results of the substance monitoring in the CBT treatment, so that it becomes a combination treatment.