Condition category
Mental and Behavioural Disorders
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
Some people being receiving opioid substitution treatment (OST) with drugs like methadone, subutex, or suboxone either drop out of treatment early or continue to use heroin. Researchers in the USA have found that drug treatment clinics can help service users stay in treatment and reduce their heroin use by offering them shop vouchers. We call this positive reinforcement or contingency management (CM). Contingency Management has a strong evidence base in the US and has been recommended by National Institute for Health and Clinical Excellence (NICE) for UK implementation. However, the UK has little track record of applying contingency management in drug treatment. To find out if positive reinforcement might be helpful in reducing use of street heroin among opiate users receiving OST here in the UK, we are going to compare providing usual OST (methadone or subutex) to providing usual treatment with positive reinforcement.

Who can participate?
Heroin users, men and women, aged over 18 years, presenting to drug clinics for opiate treatment will be screened for eligibility for this trial.

What does the study involve?
The participating clinics will be randomly assigned to one of three treatment interventions: usual treatment (OST plus key work sessions), usual treatment plus positive reinforcement of attendance or usual treatment plus positive reinforcement of abstinence. Incentives will be vouchers exchangeable for goods/services. After week 12, the contingency management will be stopped and all participants will receive only usual care. Urine samples will be collected at various stages of the study. The practical problems encountered in recruiting sites, clinical staff and patients to this trial will be examined.

What are the possible benefits and risks of participating?
There are no immediate benefits from taking part. Participants will have a chance of receiving shop vouchers for attending interviews and key work sessions or providing urine samples negative for heroin. Participants involvement in the research could help improve the care provided at drug treatment clinics. The information we get from this research will help us develop better opiate treatment programmes in the future. However, participants may be asked to attend more key work sessions and provide more urine samples than usual.

Where is the study run from?
Institute of Psychiatry, Kings College London

When is the study starting and how long is it expected to run for?
The study started in November 2012 and will run until April 2014.

Who is funding the study?
The study is funded by the National Institute for Health Research (NIHR), UK.

Who is the main contact?
Dr Nicola Metrebian

Trial website

Contact information



Primary contact

Dr Nicola Metrebian


Contact details

Addictions Department
Institute of Psychiatry
Kings College London
4 Windsor Walk
Denmark Hill
United Kingdom

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Cluster randomised controlled trial of two Contingency Management schedules targeting treatment attendance or abstinence from street heroin use in people treated for heroin dependence



Study hypothesis

The aim of the trial is to implement, observe and assess the acceptability, feasibility and clinical and cost effectiveness of CM strategies to improve treatment attendance and abstinence from heroin.

This trial is part of a larger programme of research. The trial is a multi-centre stratified cluster randomised trial (CRT) measuring OST outcomes with one of: (a) TAU + 12 week schedule of weekly keywork appointments (no praise or voucher); (b) TAU + 12 week positive reinforcement (praise &voucher) for attending scheduled weekly keywork appointments; (c) TAU + 12 week positive reinforcement (praise and voucher) for providing a weekly urine sample negative for opiates.

We will compare results for the primary outcome at the 3rd month (weeks 9-12) in all 3 treatment conditions. Each of the 33 clinics will be their own cluster. Each clinic/cluster will be randomly assigned to one of the above trial arms (ie. 20 participants per cluster, 11 clusters per arm, 220 participants in each arm and 660 in total).

After week 12, there will be complete cessation of rewards. In the follow-up phase (weeks 13-24) all participants will receive identical care with no CM. All primary and secondary outcomes at 12 weeks will be reassessed at 24 weeks for all participants. In addition, the number of opiate-negative urine test results during weeks 21-24 will be assessed.

Both CM schedules will offer the same valve of incentive over a 12 week period, but with different target behaviours (attendance vs abstinence). Incentives will be vouchers exchangeable at general supermarket chains.

The outcome of the trial will be determined by the mean number of urine tests results negative for opiates during weeks 9-12.
The trial data will also be used to model differential costs of the two CM schedules vs current practice.

A process evaluation will be conducted alongside the trial, in order to understand the implementation, delivery, fidelity and outcome of the trial intervention.

More details can be found at:

Ethics approval

NRES Committee South East Coast - Surrey, 25 July 2012 ref: 12/LO/0910

Study design

Randomised interventional trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet


Mental Health Research Network; Addictions


Contingency Management, A psychological intervention using positive reinforcement (usually in the form of praise and vouchers which can be exchangeable for goods ) to encourage engagement with treatment and to promote behaviours congruent with treatment goals. This intervention is delivered as an adjunct to existing opiate substitute treatment. Group A 12 x weekly keywork session; Group B 12 x weekly keywork session with CM (attendance); Group C 12 x weekly keywork session with CM (attendance & urine screens).
Follow Up Length: 3 months

Intervention type



Not Applicable

Drug names

Primary outcome measures

Mean number of opiate negative urine test results during weeks 9-12

Secondary outcome measures

1. Retention in treatment at the 3-month and 6-month follow-up
2. Urine test results at the 6-month follow-up (3 months post-CM)
3. Indices of physical, psychological and social well-being
4. Health economic and criminal justice outcomes

Overall trial start date


Overall trial end date


Reason abandoned


Participant inclusion criteria

1. Aged >18 years
2. Seeking new episode of OST treatment
3. Agree to 12 week treatment programme promoting abstinence
4. Regular users of street heroin in preceding month (self report 15/30 use and all UDS in past 4 weeks opiate positive)
5. Opiate dependent (meeting ICD-10 criteria) and at liberty to participate in the study for 24 weeks
6. Willing and able to provide informed consent
7. Male or female

Participant type


Age group




Target number of participants

UK Sample Size: 660; Description: 33 clusters each with 20 participants

Participant exclusion criteria

1. Pregnant or breastfeeding
2. Active mental health problem
3. Patients referred into treatment under a criminal justice order
4. Patients who cannot read English AND require the service of an interpreter to understand a brief oral description of the study

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

Addictions Department
United Kingdom

Sponsor information


South London & Maudsley NHS Foundation Trust and Kings College London (UK)

Sponsor details

c/o Ms Jenny Liebscher
SLaM R&D Office
Room W1.08
Institute of Psychiatry
De Crespigny Park
Denmark Hill
United Kingdom

Sponsor type

Hospital/treatment centre



Funder type


Funder name

NIHR Programme Grants for Applied Research ref: RP-PG-0707-10149 (UK)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Results - basic reporting

Publication summary

Publication citations

Additional files

Editorial Notes