Substance Abuse Clinical Trial
Official title:
Abstinence-Linked Money Management
This is a randomized controlled trial to test whether a money-management based intervention reduces substance abuse.
While the Social Security Administration (SSA) no longer provides benefits for individuals
disabled by drug abuse per se, approximately 50% of recipients have a concomitant substance
abuse disorder. Supported by disability payments, this substance abuse impedes
recovery/remission from the comorbid mental disorder. Money management is widely implemented
in dual diagnosis treatment - in patients assigned payees to manage their funds and in
patients receiving case management - but whether money management reduces substance abuse is
unproven. If shown to be effective, money management-based therapy can be logically
integrated into these existing arrangements. There is no specific substance abuse focus to
standard payee and case management arrangements.
We have developed a money management-based therapy called Advisor-Teller money manager (the
bank-like acronym is ATM). ATM involves having a patient voluntarily allow a therapist/money
manager to limit the patients' access to his/her funds, thus preventing unrestricted access
to cash from cueing substance use. Patients meet with therapist/money managers at least
weekly. Meetings begin with a review of the previous week's expenditures, including
expenditures for drugs and alcohol, and an on-site urine toxicology test and breathalyzer.
Patients then plan a budget that is incompatible with drug use by budgeting funds for direct
payment of expenses (such as rent), abstinence-compatible activities and long-term goals.
Budgeting and planning will develop patients' skills at managing their funds. Dispensing
procedures build upon the principles of therapeutic contracting. Patients contract to receive
their funds for specific expenditures and then review the next week whether the funds were
spent as planned.
We are conducting a Stage 2 randomized clinical trial in which 120 patients will be randomly
assigned to 36-weeks of either ATM or Finance Instruction Therapy (FIT), a low intensity
intervention in which patients are given basic financial instruction to determine the
efficacy of ATM in reducing substance use.
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