Home > Clinical and cost-effectiveness of contingency management for cannabis use in early psychosis: the CIRCLE randomised clinical trial.

Sheridan Rains, Luke and Marston, Louise and Hinton, Mark and Marwaha, Steven and Craig, Thomas and Fowler, David and King, Michael and Omar, Rumana Z and McCrone, Paul and Spencer, Jonathan and Taylor, Joanne and Colman, Sophie and Harder, Catherine and Gilbert, Eleanor and Randhawa, Amie and Labuschagne, Kirsty and Jones, Charlotte and Stefanidou, Theodora and Christoforou, Marina and Caig, Meghan and Strang, John and Weaver, Tim and Johnson, Sonia [Biomed Central] . (2019) Clinical and cost-effectiveness of contingency management for cannabis use in early psychosis: the CIRCLE randomised clinical trial. BMC Medicine, 17 (161)

URL: https://bmcmedicine.biomedcentral.com/articles/10....


Background: Cannabis is the most commonly used illicit substance amongst people with psychosis. Continued cannabis use following the onset of psychosis is associated with poorer functional and clinical outcomes. However, finding effective ways of intervening has been very challenging. We examined the clinical and cost-effectiveness of adjunctive contingency management (CM), which involves incentives for abstinence from cannabis use, in people with a recent diagnosis of psychosis.

 

Methods: CIRCLE was a pragmatic multi-centre randomised controlled trial. Participants were recruited via Early Intervention in Psychosis (EIP) services across the Midlands and South East of England. They had had at least one episode of clinically diagnosed psychosis (affective or non-affective); were aged 18 to 36; reported cannabis use in at least 12 out of the previous 24 weeks; and were not currently receiving treatment for cannabis misuse, or subject to a legal requirement for cannabis testing. Participants were randomised via a secure web-based service 1:1 to either an experimental arm, involving 12 weeks of CM plus a six-session psychoeducation package, or a control arm receiving the psychoeducation package only. The total potential voucher reward in the CM intervention was £240. The primary outcome was time to acute psychiatric care, operationalised as admission to an acute mental health service (including community alternatives to admission). Primary outcome data were collected from patient records at 18 months post-consent by assessors masked to allocation. The trial was registered with the ISRCTN registry, number ISRCTN33576045.

 

Results: Five hundred fifty-one participants were recruited between June 2012 and April 2016. Primary outcome data were obtained for 272 (98%) in the CM (experimental) group and 259 (95%) in the control group. There was no statistically significant difference in time to acute psychiatric care (the primary outcome) (HR 1.03, 95% CI 0.76, 1.40) between groups. By 18 months, 90 (33%) of participants in the CM group, and 85 (30%) of the control groups had been admitted at least once to an acute psychiatric service. Amongst those who had experienced an acute psychiatric admission, the median time to admission was 196 days (IQR 82, 364) in the CM group and 245 days (IQR 99, 382) in the control group. Cost-effectiveness analyses suggest that there is an 81% likelihood that the intervention was cost-effective, mainly resulting from higher mean inpatient costs for the control group compared with the CM group; however, the cost difference between groups was not statistically significant. There were 58 adverse events, 27 in the CM group and 31 in the control group.

 

Conclusions: Overall, these results suggest that CM is not an effective intervention for improving the time to acute psychiatric admission or reducing cannabis use in psychosis, at least at the level of voucher reward offered.

Item Type:Evidence resource
Drug Type:Cannabis
Intervention Type:AOD disorder treatment method, Alternative medical treatment, Psychosocial treatment method, Rehabilitation/Recovery
Source:Biomed Central
Date:August 2019
Volume:17
Number:161
EndNote:View
Subjects:B Substances > Cannabis / Marijuana
G Health and disease > Substance related disorder > Substance related mental disorder
HJ Treatment method > Treatment outcome
J Health care, prevention and rehabilitation > Patient care management
J Health care, prevention and rehabilitation > Treatment and maintenance > Treatment factors
J Health care, prevention and rehabilitation > Treatment and maintenance > Patient attitude toward treatment
J Health care, prevention and rehabilitation > Care by type of problem > Mental health care
L Social psychology and related concepts > Inducement for participation (incentive)
VA Geographic area > Europe > United Kingdom > England

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