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

Article


Sheridan Rains, L., Marston, L., Hinton, M., Marwaha, S., Craig, T., Fowler, D., King, M., Omar, R., McCrone, P., Spencer, J., Taylor, J., Colman, S., Harder, C., Gilbert, E., Randhawa, A., Labuschagne, K., Jones, C., Stefanidou, T., Christoforou, M., Craig, M., Strang, J., Weaver, T. and Johnson, S. 2019. Clinical and cost-effectiveness of contingency management for cannabis use in early psychosis: the CIRCLE randomised clinical trial. BMC Medicine. 17 (1), pp. 1-17. https://doi.org/10.1186/s12916-019-1395-5
TypeArticle
TitleClinical and cost-effectiveness of contingency management for cannabis use in early psychosis: the CIRCLE randomised clinical trial
AuthorsSheridan Rains, L., Marston, L., Hinton, M., Marwaha, S., Craig, T., Fowler, D., King, M., Omar, R., McCrone, P., Spencer, J., Taylor, J., Colman, S., Harder, C., Gilbert, E., Randhawa, A., Labuschagne, K., Jones, C., Stefanidou, T., Christoforou, M., Craig, M., Strang, J., Weaver, T. and Johnson, S.
Abstract

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. 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. 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. 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.

KeywordsCannabis, Contingency management, Early intervention, Financial incentives, Psychosis, Substance misuse
LanguageEnglish
PublisherBioMed Central
JournalBMC Medicine
ISSN1741-7015
Publication dates
Online15 Aug 2019
Print01 Dec 2019
Publication process dates
Deposited29 Aug 2019
Accepted22 Jul 2019
Output statusPublished
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Copyright Statement

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Digital Object Identifier (DOI)https://doi.org/10.1186/s12916-019-1395-5
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The Offender Personality Disorder pathway for women in England and Wales: a hopeful new development?
Cohen, R., Trebilcock, J., Weaver, T. and Moran, P. 2019. The Offender Personality Disorder pathway for women in England and Wales: a hopeful new development? Criminal Behaviour and Mental Health. 29 (5-6), pp. 257-260. https://doi.org/10.1002/cbm.2127
Use of SMS texts for facilitating access to online alcohol interventions: a feasibility study
Wallace, P., Andrews, M., Daley, K., Shenker, D., Gallagher, L., Watson, R., Weaver, T. and O’Donnell, A. 2017. Use of SMS texts for facilitating access to online alcohol interventions: a feasibility study. 14th annual conference of INEBRIA. New York, NY, USA 14 - 15 Sep 2017 BioMed Central. https://doi.org/10.1186/s13722-017-0087-8
Psychological Support for Personality (PSP) versus treatment as usual: study protocol for a feasibility randomized controlled trial of a low intensity intervention for people with personality disorder
Crawford, M., Thana, L., Parker, J., Turner, O., Xing, K., McMurran, M., Moran, P., Weaver, T., Barrett, B., Claringbold, A., Bassett, P. and Sanatinia, R. 2018. Psychological Support for Personality (PSP) versus treatment as usual: study protocol for a feasibility randomized controlled trial of a low intensity intervention for people with personality disorder. Trials. 19. https://doi.org/10.1186/s13063-018-2920-0
Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management
Metrebian, N., Weaver, T., Pilling, S., Hellier, J., Byford, S., Shearer, J., Mitcheson, L., Astbury, M., Bijral, P., Bogdan, N., Bowden-Jones, O., Day, E., Dunn, J., Finch, E., Forshall, S., Glasper, A., Morse, G., Akhtar, S., Bajaria, J., Bennett, C., Bishop, E., Charles, V., Davey, C., Desai, R., Goodfellow, C., Haque, F., Little, N., McKechnie, H., Morris, J., Mosler, F., Mutz, J., Pauli, R., Poovendran, D., Slater, E. and Strang, J. 2018. Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management. Contemporary Clinical Trials. 71, pp. 124-132. https://doi.org/10.1016/j.cct.2018.06.008
Feasibility trial of a psychoeducational intervention for parents with personality difficulties: The Helping Families Programme
Day, C., Briskman, J., Crawford, M., Harris, L., McCrone, P., McMurran, M., Moran, P., Morgan, L., Scott, S., Stahl, D., Ramchandani, P. and Weaver, T. 2017. Feasibility trial of a psychoeducational intervention for parents with personality difficulties: The Helping Families Programme. Contemporary Clinical Trials Communications. 8, pp. 67-74. https://doi.org/10.1016/j.conctc.2017.08.002
Activity and views of service users involved in mental health research: UK survey
Patterson, S., Trite, J. and Weaver, T. 2014. Activity and views of service users involved in mental health research: UK survey. British Journal of Psychiatry. 205 (1), pp. 68-75. https://doi.org/10.1192/bjp.bp.113.128637
Mind how you cross the gap! Outcomes for young people who failed to make the transition from child to adult services: the TRACK Study
Islam, Z., Ford, T., Kramer, T., Paul, M., Parsons, H., Harley, K., Weaver, T., McLaren, S. and Singh, S. 2016. Mind how you cross the gap! Outcomes for young people who failed to make the transition from child to adult services: the TRACK Study. BJPsych Bulletin. 40 (3), pp. 142-148. https://doi.org/10.1192/pb.bp.115.050690
An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence
Rafia, R., Dodd, P., Brennan, A., Meier, P., Hope, V., Ncube, F., Byford, S., Tie, H., Metrebian, N., Hellier, J., Weaver, T. and Strang, J. 2016. An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence. Addiction. 111 (9), pp. 1616-1627. https://doi.org/10.1111/add.13385
Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network
Borschmann, R., Patterson, S., Poovendran, D., Wilson, D. and Weaver, T. 2014. Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network. BMC Medical Research Methodology. 14 (1), p. 23. https://doi.org/10.1186/1471-2288-14-23
Monitoring and management of metabolic abnormalities: mixed-method evaluation of a successful intervention
Wilson, E., Randall, C., Patterson, S., Emmerson, B., Moudgil, V. and Weaver, T. 2014. Monitoring and management of metabolic abnormalities: mixed-method evaluation of a successful intervention. Australasian Psychiatry. 22 (3), pp. 248-253. https://doi.org/10.1177/1039856214529000
The effect of organisational resources and eligibility issues on transition from child and adolescent to adult mental health services
Belling, R., McLaren, S., Paul, M., Ford, T., Kramer, T., Weaver, T., Hovish, K., Islam, Z., White, S. and Singh, S. 2014. The effect of organisational resources and eligibility issues on transition from child and adolescent to adult mental health services. Journal of Health Services Research & Policy. 19 (3), pp. 169-176. https://doi.org/10.1177/1355819614527439
Hearing voices simulation: Process and outcomes of training
Patterson, S., Goulter, N. and Weaver, T. 2014. Hearing voices simulation: Process and outcomes of training. Journal of Mental Health Training, Education and Practice. 9 (1), pp. 46-58. https://doi.org/10.1108/JMHTEP-01-2013-0003
Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial
Weaver, T., Metrebian, N., Hellier, J., Pilling, S., Charles, V., Little, N., Poovendran, D., Mitcheson, L., Ryan, F., Bowden-Jones, O., Dunn, J., Glasper, A., Finch, E. and Strang, J. 2014. Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial. The Lancet. 384 (9938), pp. 153-163. https://doi.org/10.1016/S0140-6736(14)60196-3
Multi-method Evaluation of the Management, Organisation and Staffing (MEMOS) in high security treatment services for people with Dangerous and Severe Personality Disorder (DSPD)
Trebilcock, J. and Weaver, T. 2010. Multi-method Evaluation of the Management, Organisation and Staffing (MEMOS) in high security treatment services for people with Dangerous and Severe Personality Disorder (DSPD). Personality Disorder Team.
Everybody knows that the prisoner is going nowhere: Parole Board members’ views about dangerous and severe personality disorder in England and Wales
Trebilcock, J. and Weaver, T. 2012. Everybody knows that the prisoner is going nowhere: Parole Board members’ views about dangerous and severe personality disorder in England and Wales. International Journal of Criminology and Sociology. 1, pp. 141-150. https://doi.org/10.6000/1929-4409.2012.01.14
Changing legal characteristics of dangerous and severe personality disorder (DSPD) patients and prisoners
Trebilcock, J. and Weaver, T. 2012. Changing legal characteristics of dangerous and severe personality disorder (DSPD) patients and prisoners. Journal of Forensic Psychiatry and Psychology. 23 (2), pp. 237-243. https://doi.org/10.1080/14789949.2012.668212
It doesn't have to be treatable: Mental Health Review Tribunal (MHRT) members’ views about Dangerous and Severe Personality Disorder (DSPD)
Trebilcock, J. and Weaver, T. 2012. It doesn't have to be treatable: Mental Health Review Tribunal (MHRT) members’ views about Dangerous and Severe Personality Disorder (DSPD). Journal of Forensic Psychiatry and Psychology. 23 (2), pp. 244-260. https://doi.org/10.1080/14789949.2012.668208
‘Talking a different language’: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services
McLaren, S., Belling, R., Paul, M., Ford, T., Kramer, T., Weaver, T., Hovish, K., Islam, Z., White, S. and Singh, S. 2013. ‘Talking a different language’: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services. BMC Health Services Research. 13. https://doi.org/10.1186/1472-6963-13-254
Residents’ perceptions of water quality improvements following remediation work in the Pymme’s Brook catchment, north London, UK
Faulkner, H., Green, A., Pellaumail, K. and Weaver, T. 2001. Residents’ perceptions of water quality improvements following remediation work in the Pymme’s Brook catchment, north London, UK. Journal of Environmental Management. 62 (3), pp. 239-254. https://doi.org/10.1006/jema.2001.0435