Psych CASC / OSCE · Addiction psychiatry — psychosocial interventions
Negotiate contingency management and mutual-help after stimulant relapse — CASC communication station
MRCPsych/FRANZCP-style communication station: explain CM mechanism and protocol, destigmatise testing, offer secular mutual-help, set boundaries against coercive AA, shared plan and teach-back.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. Examiner may play patient and/or mother. [1]
Candidate instructions. Explain contingency management in plain language. Address the bribery concern without defensiveness. Describe thrice-weekly testing as clinical verification, not moral judgment. Offer SMART Recovery as secular mutual-help; do not force AA. Negotiate a collaborative 12-week plan. Check understanding. [2][3]
Candidate scenario
He smokes methamphetamine most days, lost employment, is not opioid-dependent, and has no acute psychosis today. Clinic can run thrice-weekly urine CM with escalating gift cards for negative tests and reset after positive tests. SMART Recovery online and in-person options exist. Mother is frightened and wants compulsory AA. [1][3]
Marking domains
- Empathy with shame about testing and mother’s fear
- Accurate plain-language CM explanation (verify → immediate reward → escalate/reset)
- Bribery reframe with evidence posture (not numbers dump)
- Secular mutual-help offer; no coercive AA
- Shared plan and teach-back
- Safety-net if craving/suicide risk rises [1][2][3][4]
Reveal assessor key
Open. Name role and time; ask patient and mother top concerns (humiliation vs death/job loss). Validate both.[4]
CM explanation. “We are not bribing you to be a good person. Meth gives a quick reward; we temporarily make not using also give a quick, fair reward when a test confirms it — several times a week — then build skills and peer support so life rewards take over.” Mention escalating rewards and that a positive test means missing that day’s reward, not automatic exile.[1][2]
Evidence posture. “Programmes like this have been studied for methamphetamine and other drugs and help people stay abstinent during treatment.” Avoid overclaiming permanent cure; plan aftercare.[1][5]
Mutual-help. Offer SMART Recovery as requested secular option; explain AA is voluntary and not required; mother can seek Al-Anon-type family support without forcing him into meetings.[3][4]
Close. Written plan: CM schedule, first SMART meeting, crisis numbers, review date; teach-back of what happens after a positive test.[1][3]
References
- [1]Roll JM, et al. Contingency management for the treatment of methamphetamine use disorders Am J Psychiatry, 2006.PMID 17074952
- [2]Prendergast M, et al. Contingency management for treatment of substance use disorders: a meta-analysis Addiction, 2006.PMID 17034434
- [3]Zemore SE, et al. A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD J Subst Abuse Treat, 2018.PMID 29606223
- [4]Humphreys K, et al. Self-help organizations for alcohol and drug problems J Subst Abuse Treat, 2004.PMID 15063905
- [5]Dutra L, et al. A meta-analytic review of psychosocial interventions for substance use disorders Am J Psychiatry, 2008.PMID 18198270