2 Research recommendations
The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and care of service users in the future.
Which methods of implementing contingency management (including delivering and stopping incentives) and which settings (including legally mandated, community-based and residential), compared with one another and with standard care, are associated with the longest periods of continued abstinence and reduced drug misuse, and with maintenance of abstinence/reduction of drug misuse at follow-up?
Although the efficacy of contingency management for drug misuse has been extensively investigated, there is a lack of large-scale and well-conducted implementation studies. The implementation of contingency management programmes in the UK would be aided by research assessing specific components of the programme.
For people who misuse drugs and who are participating in contingency management, which method of testing, urinalysis, sweat analysis or oral fluid analysis, is most sensitive, specific, cost effective and acceptable to service users?
There is a lack of data comparing the sensitivity and specificity, cost effectiveness and acceptability to service users of these methods of testing. Identifying drug use during treatment is an important aspect of contingency management; identifying which testing methods are the most effective is important for health and social care services intending to implement contingency management programmes.
Is residential treatment associated with higher rates of abstinence or reduction in drug misuse than community-based care?
There have been some studies comparing residential treatment with community-based treatment. However, these studies are often based on small sample sizes, lack methodological quality and have produced inconsistent results. Residential treatment requires significantly more resources than community-based treatment, so it is important to assess whether residential treatment is more effective.