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Davidson RM, Brown HD, Regnier SD, DeFulio A. Incentivized collaborative care to disseminate and enhance contingency-management services. J Appl Behav Anal 2024. [PMID: 39004776 DOI: 10.1002/jaba.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/06/2024] [Indexed: 07/16/2024]
Abstract
Contingency management is especially effective in supporting medication adherence and drug abstinence among people with opioid use disorder. However, the incorporation of contingency management into clinical practice has been slow. The present study was designed to evaluate the feasibility, acceptability, and usability of incentives for providers as a means of accelerating collaborative care with contingency management. Thirteen buprenorphine prescribers served as participants in a nonexperimental study. The prescribers who referred patients to a contingency-management service received monetary incentives for reviewing patient performance data and describing their use of these data in treatment decisions. The results show that this approach is feasible, acceptable, and easy to use for everyone involved. Self-reports indicate improved prescriber-patient relationships and more informed care. However, prescriber-focused incentives did not appear to greatly enhance access to contingency-management services for patients. Thus, provider incentives may be beneficial but further research is needed to advance adoption of contingency management.
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Affiliation(s)
| | - Hayley D Brown
- Department of Psychology, Western Michigan University, Kalamazoo, MI, USA
| | - Sean D Regnier
- Department of Psychology, Western Michigan University, Kalamazoo, MI, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Anthony DeFulio
- Department of Psychology, Western Michigan University, Kalamazoo, MI, USA
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Oesterle TS, Hall-Flavin DK, Bormann NL, Loukianova LL, Fipps DC, Breitinger SA, Gilliam WP, Wu T, da Costa SC, Arndt S, Karpyak VM. Therapeutic Content of Mobile Phone Applications for Substance Use Disorders: An Umbrella Review. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2024; 2:192-206. [PMID: 38983444 PMCID: PMC11232654 DOI: 10.1016/j.mcpdig.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Mobile phone applications (MPAs) for substance use disorder (SUD) treatment are increasingly used by patients. Although pilot studies have shown promising results, multiple previous systematic reviews noted insufficient evidence for MPA use in SUD treatment-many of the previously published reviews evaluated different trials. Subsequently, we aimed to conduct an umbrella review of previously published reviews investigating the efficacy of MPAs for SUD treatment, excluding nicotine/tobacco because umbrella reviews have been done in this population and the nicotine/tobacco MPA approach often differs from SUD-focused MPAs. No previous reviews have included a statistical meta-analysis of clinical trials to quantify an estimated overall effect. Seven reviews met inclusion criteria, and 17 unique studies with available data were taken from those reviews for the meta-analysis. Overall, reviews reported a lack of evidence for recommending MPAs for SUD treatment. However, MPA-delivered recovery support services, cognitive behavioral therapy, and contingency management were identified across multiple reviews as having promising evidence for SUD treatment. Hedges g effect size for an MPA reduction in substance use-related outcomes relative to the control arm was insignificant (0.137; 95% CI, -0.056 to 0.330; P=.16). In subgroup analysis, contingency management (1.29; 95% CI, 1.088-1.482; τ 2=0; k=2) and cognitive behavioral therapy (0.02; 95% CI, 0.001-0.030; τ 2=0; k=2) were significant. Although contingency management's effect was large, both trials were small (samples of 40 and 30). This review includes an adapted framework for the American Psychiatric Association's MPA guidelines that clinicians can implement to review MPAs critically with patients.
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Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Daniel K Hall-Flavin
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Nicholas L Bormann
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Larissa L Loukianova
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - David C Fipps
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Wesley P Gilliam
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Tiffany Wu
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Sabrina Correa da Costa
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Stephan Arndt
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
| | - Victor M Karpyak
- Department of Psychiatry and Psychology (T.S.O., D.K.H.-F., N.L.B., L.L.L., D.C.F., S.A.B., W.P.G., S.C.d.C., V.M.K.), Mayo Clinic, Rochester, MN; Department of Gastroenterology and Hepatology (T.W.), Mayo Clinic, Rochester, MN; Department of Psychiatry (S.A.), University of Iowa, Iowa City, IA; and Department of Biostatistics (S.A.), University of Iowa, Iowa City, IA
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The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. J Addict Med 2024; 18:1-56. [PMID: 38669101 PMCID: PMC11105801 DOI: 10.1097/adm.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The American Society of Addiction Medicine/American Academy of Addiction Psychiatry (ASAM/AAAP) Clinical Practice Guideline on the Management of Stimulant Use Disorder provides guidance on evidence-based strategies for the treatment of stimulant use disorders (StUDs), stimulant intoxication, and stimulant withdrawal, as well as secondary and tertiary prevention of harms associated with stimulant use. The Clinical Guideline Committee (CGC) comprised experts from ASAM and AAAP representing a range of clinical settings and patient populations. The guideline was developed following modified GRADE methodology. The process included a systematic literature review as well as several targeted supplemental searches. The CGC utilized Evidence to Decision tables to review available evidence and rate the strength of each recommendation. The clinical practice guideline was revised based on external stakeholder review. Key takeaways included: Contingency management represents the current standard of care for treatment of StUDs; Pharmacotherapies may be utilized off-label to treat StUDs; Acute stimulant intoxication can result in life-threatening complications that should be addressed in an appropriate level of care; Secondary and tertiary prevention strategies should be used to reduce harms related to risky stimulant use.
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Dallery J, Ives L, Knerr A. Toward an era of impact of digital contingency management in the treatment of substance use disorders. Prev Med 2023; 176:107518. [PMID: 37080501 DOI: 10.1016/j.ypmed.2023.107518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 04/22/2023]
Abstract
Digital contingency management entails remote methods to obtain biochemical confirmation of drug status and provide desirable, tangible consequences contingent on abstinence. Advances in digital CM suggest that it may be on the cusp of making a public health impact. Specific advances include technological capabilities and affordability, companies that specialize in digital CM, policies and reimbursement models, and the increasing availability of resources related to CM. Digital CM has expanded from cigarette smoking to alcohol and illicit substance misuse, and to include a diverse range of underserved and high-risk groups (e.g., pregnant and postpartum women, socioeconomically disadvantaged individuals, adolescents, and rural populations). Although the digital divide continues to narrow, culturally responsive methods may increase uptake and engagement with digital CM. The promise of digital CM is widescale access to an evidence-based treatment with low staff burden, no side effects, high fidelity engagement, acceptability, and effectiveness, and greater equity. We may be close to realizing this promise.
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Clay S, Wilkinson Z, Ginley M, Arunogiri S, Christmass M, Membrey D, MacCartney P, Sutherland R, Colledge-Frisby S, Marshall AD, Nagle J, Degenhardt L, Farrell M, McKetin R. Perspectives and sentiments on contingency management from people who use methamphetamine. Drug Alcohol Rev 2023; 42:1427-1437. [PMID: 37248676 DOI: 10.1111/dar.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Contingency management (CM) is currently the most efficacious treatment for methamphetamine use, yet it is rarely available in routine care. We examined the viewpoints of people who use methamphetamine on CM as a potential treatment for methamphetamine use disorder. METHODS Semi-structured qualitative interviews with 30 Australians aged 18 years or older who had used methamphetamine at least weekly in the past 6 months. RESULTS Participants reported overall positive attitudes towards CM as a potential treatment option for methamphetamine use disorder. However, there was need for greater flexibility in meeting participant treatment goals (e.g., reduced use or complete abstinence), with particular concern about the viability of initiating abstinence, both in terms of the sufficiency of the initial financial incentive and managing withdrawal symptoms. There was strong interest in the use of digital technologies to provide remote CM, particularly around the convenience and flexibility this offered. Despite this, participants remained keen to access adjunctive treatment and support services but stressed that engagement with these additional services should not be mandatory. Marketing of CM will need to address preconceptions about drug-testing used in abstinence-based CM being punitive (especially urine testing) and its connotations with criminal justice interventions. DISCUSSION AND CONCLUSION Positive attitudes towards CM bode well for potential uptake should CM be made available in routine clinical practice. However, there is a need to adapt CM to ensure it is feasible and attractive to people who are seeking treatment for methamphetamine use disorder.
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Affiliation(s)
- Simon Clay
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Zachary Wilkinson
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Meredith Ginley
- East Tennessee State University, Johnson City, Tennessee, USA
| | - Shalini Arunogiri
- Turning Point & Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Michael Christmass
- Next Step Community Alcohol and Other Drugs Service, Mental Health Commission, Perth, Australia
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- National Drug Research Institute, Melbourne, Australia
| | - Alison D Marshall
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Jack Nagle
- Connections Based Living, Melbourne, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Hallgren KA, Duncan MH, Iles-Shih MD, Cohn EB, McCabe CJ, Chang YM, Saxon AJ. Feasibility, Engagement, and Usability of a Remote, Smartphone-Based Contingency Management Program as a Treatment Add-On for Patients Who Use Methamphetamine: Single-Arm Pilot Study. JMIR Form Res 2023; 7:e47516. [PMID: 37410529 PMCID: PMC10360016 DOI: 10.2196/47516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/11/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND In the United States, methamphetamine-related overdoses have tripled from 2015 to 2020 and continue to rise. However, efficacious treatments such as contingency management (CM) are often unavailable in health systems. OBJECTIVE We conducted a single-arm pilot study to evaluate the feasibility, engagement, and usability of a fully remotely delivered mobile health CM program offered to adult outpatients who used methamphetamine and were receiving health care within a large university health system. METHODS Participants were referred by primary care or behavioral health clinicians between September 2021 and July 2022. Eligibility criteria screening was conducted by telephone and included self-reported methamphetamine use on ≥5 out of the past 30 days and a goal of reducing or abstaining from methamphetamine use. Eligible participants who agreed to take part then completed an initial welcome phase that included 2 videoconference calls to register for and learn about the CM program and 2 "practice" saliva-based substance tests prompted by a smartphone app. Participants who completed these welcome phase activities could then receive the remotely delivered CM intervention for 12 consecutive weeks. The intervention included approximately 24 randomly scheduled smartphone alerts requesting a video recording of themselves taking a saliva-based substance test to verify recent methamphetamine abstinence, 12 weekly calls with a CM guide, 35 self-paced cognitive behavioral therapy modules, and multiple surveys. Financial incentives were disbursed via reloadable debit cards. An intervention usability questionnaire was completed at the midpoint. RESULTS Overall, 37 patients completed telephone screenings, with 28 (76%) meeting the eligibility criteria and consenting to participate. Most participants who completed a baseline questionnaire (21/24, 88%) self-reported symptoms consistent with severe methamphetamine use disorder, and most had other co-occurring non-methamphetamine substance use disorders (22/28, 79%) and co-occurring mental health disorders (25/28, 89%) according to existing electronic health records. Overall, 54% (15/28) of participants successfully completed the welcome phase and were able to receive the CM intervention. Among these participants, engagement with substance testing, calls with CM guides, and cognitive behavioral therapy modules varied. Rates of verified methamphetamine abstinence in substance testing were generally low but varied considerably across participants. Participants reported positive opinions about the intervention's ease of use and satisfaction with the intervention. CONCLUSIONS Fully remote CM can be feasibly delivered within health care settings lacking existing CM programs. Although remote delivery may help reduce barriers to treatment access, many patients who use methamphetamine may struggle to engage with initial onboarding. High rates of co-occurring psychiatric conditions in the patient population may also contribute to uptake and engagement challenges. Future efforts could leverage greater human-to-human connection, more streamlined onboarding procedures, larger incentives, longer durations, and the incentivization of non-abstinence-based recovery goals to increase uptake and engagement with fully remote mobile health-based CM.
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Mark H Duncan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Matthew D Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Eliza B Cohn
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Connor J McCabe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Yanni M Chang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Center of Excellence in Substance Addiction Treatment and Education, Veterans Health Administration Puget Sound Health Care System, Seattle, WA, United States
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DeFulio A, Brown HD, Davidson RM, Regnier SD, Kang N, Ehart M. Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone-Based Contingency Management Intervention for Buprenorphine Adherence. Behav Anal Pract 2023; 16:450-458. [PMID: 37187840 PMCID: PMC10170006 DOI: 10.1007/s40617-022-00730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 10/17/2022] Open
Abstract
Buprenorphine is an important medication for treating opioid use disorder, but medication adherence and treatment retention are key issues that can limit its impact, especially when patients have concurrent stimulant use. Contingency management is efficacious in promoting medication adherence and drug abstinence. Delivering contingency management via smartphones addresses practical barriers to its adoption and improves patient access. A single-group (n = 20) nonexperimental study was conducted to evaluate the feasibility of smartphone-based contingency management to promote adherence to buprenorphine treatment in people with opioid use disorder. Participants were recruited from outpatient treatment clinics. Over 12 weeks participants had access to a smartphone app that provided contingency management supported with peer recovery coaching. Adherence was confirmed daily either by GPS monitoring of clinic medication visits or self-recorded video, and salivary toxicology was conducted weekly. The overall rate of confirmed buprenorphine adherence was 76%, and visual inspection of individual participant outcomes shows consistent medication use for a large majority of participants. All participants were able to successfully use all app features and spend earnings. Participants rated the app and intervention highly on measures of likability, ease of use, and helpfulness. All participants (100%) were retained in buprenorphine treatment throughout the study period. Direct methods for confirming adherence appear superior to confirmation via salivary toxicology. This study shows that smartphone-based contingency management is a feasible means of promoting buprenorphine adherence. The potential efficacy of smartphone-based contingency management as a means of promoting buprenorphine adherence warrants evaluation in a randomized controlled trial.
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Affiliation(s)
- Anthony DeFulio
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5439, Kalamazoo, MI 49008 USA
| | - Hayley D. Brown
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5439, Kalamazoo, MI 49008 USA
| | - Rosemarie M. Davidson
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5439, Kalamazoo, MI 49008 USA
| | - Sean D. Regnier
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5439, Kalamazoo, MI 49008 USA
- Present Address: College of Medicine, University of Kentucky, Lexington, KY USA
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Coughlin LN, Salino S, Jennings C, Lacek M, Townsend W, Koffarnus MN, Bonar EE. A systematic review of remotely delivered contingency management treatment for substance use. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208977. [PMID: 36804352 PMCID: PMC10936237 DOI: 10.1016/j.josat.2023.208977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/23/2022] [Accepted: 02/05/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Substance use and related consequences (e.g., impaired driving, injuries, disease transmission) continue to be major public health concerns. Contingency management (CM) is a highly effective treatment for substance use disorders. Yet CM remains vastly underutilized, in large part due to implementation barriers to in-person delivery. If feasible and effective, remote delivery of CM may reduce barriers at both the clinic- and patient-level, thus increasing reach and access to effective care. Here, we summarize data from a systematic review of studies reporting remote delivery of CM for substance use treatment. METHODS We conducted a systematic review, reported according to PRISMA guidelines. The study team identified a total of 4358 articles after deduplication. Following title and abstract screening, full-text screening, and reference tracking, 39 studies met the eligibility criteria. We evaluated the methodological quality of the included studies using the Effective Public Health Practice Project Quality tool. RESULTS Of 39 articles included in the review, most (n = 26) targeted cigarette smoking, with others focusing on alcohol (n = 9) or other substance use or targeting multiple substances (n = 4). Most remotely delivered CM studies focused on abstinence (n = 29), with others targeting substance use reduction (n = 2), intervention engagement (n = 5), and both abstinence and intervention engagement (n = 3). CM was associated with better outcomes (either abstinence, use reduction, or engagement), with increasingly more remotely delivered CM studies published in more recent years. Studies ranged from moderate to strong quality, with the majority (57.5 %) of studies being strong quality. CONCLUSIONS Consistent with in-person CM, remotely delivered CM focusing on abstinence or use reduction from substances or engagement in substance use treatment services improves outcomes at the end of treatment compared to control conditions. Moreover, remotely delivered CM is feasible across a variety of digital delivery platforms (e.g., web, mobile, and wearable), with acceptability and reduced clinic and patient burden as technological advancements streamline monitoring and reinforcer delivery.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Sarah Salino
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Claudia Jennings
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Madelyn Lacek
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mikhail N Koffarnus
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - Erin E Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Injury Prevention Center, University of Michigan, Ann Arbor, MI 48109, USA
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9
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Getty CA, Weaver T, Metrebian N. A qualitative exploration of patients' experience of mobile telephone-delivered contingency management to promote adherence to supervised methadone. Drug Alcohol Rev 2023; 42:641-651. [PMID: 36269110 DOI: 10.1111/dar.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Despite an increasing evidence base for mobile telephone-delivered contingency management (mCM), there had been no previous qualitative exploration of patients' experience of receiving mCM and the factors that might influence that experience and outcome in a UK setting. The aim of this study was to understand patients' views and experience of receiving mCM by exploring their beliefs, expectations and perceived benefits within the context of the UK's first mCM intervention. METHODS Qualitative interviews (N = 15) were conducted with patients undergoing opioid agonist treatment in a UK drug treatment service and receiving mCM to encourage adherence with supervised methadone as part of an existing study. Interviews were conducted at two time points and analysed using Framework to explore patients' expectations and beliefs during the early stage of the intervention (2 weeks) and their perceived benefits and experience at the end of the intervention (12 weeks). RESULTS The mCM was perceived as a motivator, providing validation of achievement, and involving discreet and positive interactions. Perceived benefits included enhanced methadone adherence, reduced drug use and the development of a supportive and non-judgemental connection that resembled a therapeutic alliance. DISCUSSION AND CONCLUSIONS The mechanisms underpinning contingency management appeared to operate in the absence of human interaction, and the mCM intervention was deemed to be meaningful, acceptable and well received by patients. These findings not only provide support for the application of mCM in this context but also offer insight into the factors that influence outcomes and should be considered in the development of future mCM interventions.
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Affiliation(s)
- Carol-Ann Getty
- National Addiction Centre, King's College London, London, UK
| | - Tim Weaver
- Department of Mental Health and Social Work at Middlesex University, London, UK
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Abstract
Contingency management (i.e. rewarding people, often with money, for achieving their recovery goals) is backed by decades of empirical support yet remains highly underutilized. Rewards are rarely used in real-world clinical practice due to a number of concerns, including most notably, the apparent lack of innovation, as well as moral, philosophical, ethical, and economic concerns, and even federal rules meant to prevent illegal inducements in health care. Still, other opponents argue that some patients will try to "game" the system by simply doing whatever it takes to earn monetary rewards. This paper provides a succinct, up-to-date overview of the current evidence base for contingency management for opioid use disorder. Common barriers and solutions to implementation, as well as implications for future research and clinical practice are discussed. Although important, greater uptake of contingency management interventions is about more than legislation and regulations; it's about recognizing stigma, shaping attitudes, and increasing awareness. Provider involvement in advocacy efforts at all levels and collaboration involving academic-industry partnerships is necessary to advance the burgeoning digital health care space and improve outcomes for people with opioid use disorder. Key MessagesContingency management is highly effective but highly underutilized.Low uptake is largely attributed to a lack of innovation and moral, ethical, and economic concerns, among other barriers.Technology-enabled solutions and academic-industry partnerships are critical to advance opioid use disorder care.
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Affiliation(s)
- Steven L Proctor
- Thriving Mind South Florida, Miami, FL, USA.,PRO Health Group, Miami Beach, FL, USA.,Department of Psychiatry and Behavioral Health, Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
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11
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Proctor SL, Rigg KK, Tien AY. Acceptability and Usability of a Reward-Based Mobile App for Opioid Treatment Settings: Mixed Methods Pilot Study. JMIR Form Res 2022; 6:e37474. [PMID: 36197705 PMCID: PMC9582914 DOI: 10.2196/37474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/30/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). Reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible. OBJECTIVE This mixed methods pilot study sought to determine the perceived acceptability and usability of PROCare Recovery, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micropayments to patients for achieving recovery goals via smart debit card with blocking capabilities. METHODS Participants included patients receiving buprenorphine for OUD (n=10) and licensed prescribers (n=5). Qualitative interviews were conducted by 2 PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes. RESULTS Participants were overwhelmingly in favor of microrewards (eg, US $1) to incentivize treatment participation (up to US $150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars or liquor stores, casinos or online gambling). Quantitative data revealed a high level of perceived usability of the PROCare Recovery app. CONCLUSIONS Patients and providers alike appear receptive to microfinancial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial.
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Affiliation(s)
- Steven L Proctor
- PRO Health Group, Miami Beach, FL, United States
- Thriving Mind South Florida, Miami, FL, United States
- Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Khary K Rigg
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, United States
| | - Allen Y Tien
- Medical Decision Logic, Inc, Baltimore, MD, United States
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12
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Sweeney MM, Holtyn AF, Stitzer ML, Gastfriend DR. Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions. Psychiatr Clin North Am 2022; 45:515-528. [PMID: 36055736 PMCID: PMC9352538 DOI: 10.1016/j.psc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The US opioid crisis and the COVID-19 pandemic have sparked innovation in substance use disorder (SUD) treatment such that telehealth, remote monitoring, and digital health interventions are increasingly feasible and effective. These technologies can increase SUD treatment access and acceptability, even for nontreatment seeking, remote, and underserved populations, and can be used to reduce health disparities. Overall, digital tools will likely overcome many barriers to delivery of evidence-based behavioral treatments such as cognitive behavioral therapy and contingency management, that, along with appropriate medications, constitute the foundation of treatment of SUDs.
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Affiliation(s)
- Mary M Sweeney
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA; Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
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13
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Secades-Villa R, Aonso-Diego G, González-Roz A. A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients. Int J Clin Health Psychol 2022; 22:100314. [PMID: 35662791 PMCID: PMC9157212 DOI: 10.1016/j.ijchp.2022.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background/Objective Contingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence. Method A total of 80 participants (75.8% males; Mage = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence. Results Adding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488). Conclusions CM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.
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Affiliation(s)
- Roberto Secades-Villa
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
| | - Gema Aonso-Diego
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
- Corresponding author.
| | - Alba González-Roz
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
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14
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Englund A, Sharman S, Tas B, Strang J. Could COVID expand the future of addiction research? Long-term implications in the pandemic era. Addiction 2022; 117:2135-2140. [PMID: 35038780 PMCID: PMC9542788 DOI: 10.1111/add.15790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIMS The COVID-19 pandemic has significantly impacted face-to-face research. This has propelled ideas and plans for more remote styles of research and provided new perspectives on conducting research. This paper aimed to identify challenges specific to conducting remote forms of experimental addiction research, although some of these challenges apply to all types of addiction research. ARGUMENT The impact of the COVID-19 pandemic has led to important lessons for future addiction research. Although remote research has been conducted for decades, little experimental research has been performed remotely. To do so require a new perspective on what research questions we can ask and could also enable preferential capture of those who may be more reluctant to engage in research based in clinical settings. There may, however, be crucial factors that will compromise this process. We illustrate our argument with three real-world, ongoing case studies centred on gambling behaviour, opioid overdose, and cannabinoid psychopharmacology. We highlight the obstacles to overcome to enable more remote methods of study. CONCLUSIONS The future of experimental research and, more generally, addiction research, will be shaped by the pandemic and may result in advantages, such as reaching different populations and conducting addiction research in more naturalistic settings.
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Affiliation(s)
- Amir Englund
- National Addiction Centre, Addictions DepartmentInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Stephen Sharman
- National Addiction Centre, Addictions DepartmentInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Basak Tas
- National Addiction Centre, Addictions DepartmentInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - John Strang
- National Addiction Centre, Addictions DepartmentInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
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15
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Palmer AM, Tomko RL, Squeglia LM, Gray KM, Carpenter MJ, Smith TT, Dahne J, Toll BA, McClure EA. A pilot feasibility study of a behavioral intervention for nicotine vaping cessation among young adults delivered via telehealth. Drug Alcohol Depend 2022; 232:109311. [PMID: 35123362 PMCID: PMC8885867 DOI: 10.1016/j.drugalcdep.2022.109311] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nicotine vaping among youth has increased, warranting concern from tobacco control proponents. Many youth who vape indicate interest in quitting; however, few empirically supported vaping cessation interventions exist. This pilot feasibility study adapted an established behavioral intervention, contingency management (CM), delivered via telehealth to promote vaping cessation among young adults. METHODS Participants (N = 27; ages 17-21) vaping nicotine regularly were recruited via social media and digital advertisements from across the US (June 2020-January 2021). Participants were randomized at approximately 4:1 to CM or Monitoring control (22:5). CM was delivered through DynamiCare Health's smartphone app for 4 weeks, in which financial incentives were delivered contingent on abstinent cotinine samples after the quit day until the end of treatment (EOT; Days 7-28; 10 expected submissions). Control participants earned incentives for submitting cotinine, regardless of abstinence. Feasibility, acceptability, and abstinence was collected throughout treatment, at EOT, and at 1-month follow-up. RESULTS The majority of enrolled participants completed treatment (Monitoring: 5/5; CM: 20/22), and intervention components were rated favorably overall (> 80%). CM participants submitted 112/220 (55%) abstinent cotinine samples throughout the quit attempt, while the Monitoring group submitted 4/50 (8%) negative samples. There were no differences in abstinence between groups at EOT or follow-up. CONCLUSION This pilot study of a telehealth-based youth vaping cessation intervention demonstrated preliminary feasibility and acceptability. These results suggest that CM for young adult vaping cessation, delivered remotely, is a promising direction for future work and fully powered trials are warranted to assess intervention efficacy.
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Affiliation(s)
- Amanda M. Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC USA,Department of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Carpenter
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC USA,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Tracy T. Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin A. Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC USA,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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16
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Dissemination of Contingency Management for the Treatment of Opioid Use Disorder. Perspect Behav Sci 2022; 46:35-49. [PMID: 37006603 PMCID: PMC10050478 DOI: 10.1007/s40614-022-00328-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Contingency management is an intervention for substance use disorders based on operant principles. The evidence base in support of contingency management is massive. It is effective in treating substance use disorder in general and opioid use disorder in particular. Dissemination has remained slow despite the urgency created by the opioid epidemic. Key barriers include a lack of expertise, time, and money. Implementing contingency management with smartphones eliminates the need for special training. It also solves logistical issues and requires little time on the part of clinicians. Thus, remaining barriers relate to cost. Federal anti-kickback regulations complicate solutions to the cost barrier. Other important regulatory challenges related to cost include the lack of billing codes and the difficulty of obtaining FDA approval for digital therapeutics. Even after the cost barrier is overcome, provider adoption is not guaranteed. Incentivizing providers for collaborative care may increase adoption and generate referrals. Recently proposed legislation and governmental policy statements provide optimism regarding the near-term large-scale adoption of contingency management in the treatment of opioid use disorder.
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17
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Getty CA, Weaver T, Lynskey M, Kirby KC, Dallery J, Metrebian N. Patients' beliefs towards contingency management: Target behaviours, incentives and the remote application of these interventions. Drug Alcohol Rev 2021; 41:96-105. [PMID: 34034358 DOI: 10.1111/dar.13314] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Contingency management interventions are among the most efficacious psychosocial interventions in promoting abstinence from smoking, alcohol and substance use. The aim of this study was to assess the beliefs and objections towards contingency management among patients in UK-based drug and alcohol services to help understand barriers to uptake and support the development and implementation of these interventions. METHODS The Service User Survey of Incentives was developed and implemented among patients (N = 181) at three UK-based drug and alcohol treatment services. Descriptive analyses were conducted to ascertain positive and negative beliefs about contingency management, acceptability of different target behaviours, incentives and delivery mechanisms including delivering incentives remotely using technology devices such as mobile telephones. RESULTS Overall, 81% of participants were in favour of incentive programs, with more than 70% of respondents agreeing with the majority of positive belief statements. With the exception of two survey items, less than a third of participants agreed with negative belief statements. The proportion of participants indicating a neutral response was higher for negative statements (27%) indicating greater levels of ambiguity towards objections and concerns regarding contingency management. DISCUSSION AND CONCLUSIONS Positive beliefs towards contingency management interventions were found, including high levels of acceptability towards a range of target behaviours, incentives and the use of technology devices to remotely monitor behaviour and deliver incentives. These findings have implications for the development and implementation of remote contingency management interventions within the UK drug treatment services.
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Affiliation(s)
- Carol-Ann Getty
- National Addiction Centre, King's College London, London, UK
| | - Tim Weaver
- Department of Mental Health and Social Work, Middlesex University, London, UK
| | - Michael Lynskey
- National Addiction Centre, King's College London, London, UK
| | - Kimberly C Kirby
- TRI Center on Addictions, Public Health Management Corporation, Philadelphia, USA
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, USA
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18
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DeFulio A, Devoto A, Traxler H, Cosottile D, Fingerhood M, Nuzzo P, Dallery J. Smartphone-based incentives for promoting adherence to antiretroviral therapy: A randomized controlled trial. Prev Med Rep 2021; 21:101318. [PMID: 33511028 PMCID: PMC7815813 DOI: 10.1016/j.pmedr.2021.101318] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/23/2020] [Accepted: 12/21/2020] [Indexed: 01/12/2023] Open
Abstract
Contingency management (CM) intervention can promote adherence to ART. CM for ART adherence can be delivered via a smartphone platform. Smartphone CM reduces barriers to adoption of CM relative to in-person CM. Low-income people with HIV found smartphone CM to be acceptable and easy to use. CM produced detectable ART adherence improvements despite high baseline levels.
Antiretroviral therapy can improve the lives of people living with HIV and reduce the rate of transmission. However, high levels of adherence are required. Some people living with HIV, including people who use drugs, are at elevated risk for non-adherence. Contingency management is a promising intervention for promoting adherence to antiretroviral therapy. Barriers to adoption of contingency management include lack of provider expertise and implementation effort. To address these barriers, a smartphone-based adherence intervention was developed. HIV + people with a substance use disorder were required to submit video selfies of medication consumption that met validity criteria. Monetary incentives were delivered to participants via reloadable debit cards, contingent upon a valid video. The intervention was evaluated in a small (n = 50) randomized controlled trial. Intervention participants submitted 75% of possible videos, and 81% of videos met validity criteria, indicating a high level of usability. Participants also rated the intervention as highly acceptable. Adherence was measured as the percent of participants who achieved a 95% adherence threshold, and also as the overall percent of days in which participants were adherent to their antiretroviral therapy. The former showed a significant effect for group, (p = .034) but this was not maintained when adjusting for stratification variables as covariates (p = .094). The latter measure showed a significant group × time interaction. Smartphone-based contingency management is a promising method for promoting adherence to antiretroviral therapy. Assessing the cost-benefit of the intervention and development of strategies for long-term adherence are priorities for future research.
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DeFulio A, Furgeson J, Brown HD, Ryan S. A Smartphone-Smartcard Platform for Implementing Contingency Management in Buprenorphine Maintenance Patients With Concurrent Stimulant Use Disorder. Front Psychiatry 2021; 12:778992. [PMID: 34950072 PMCID: PMC8688352 DOI: 10.3389/fpsyt.2021.778992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Opioid agonist pharmacotherapies are effective in the treatment of opioid use disorder (OUD) but concurrent stimulant use is common and can lead to relapse and treatment drop out. Contingency management in combination with opioid agonist pharmacotherapy has broad beneficial effects in polysubstance users, including promoting drug abstinence and treatment retention, but clinic-based implementation can be burdensome. The present study was conducted to evaluate a contingency management intervention delivered via a smartphone-smartcard platform in OUD patients who had concurrent stimulant use disorder. Methods: Retrospective comparison of (n = 124) patients; half received the contingency management intervention and half were matched controls. Drug use and clinic attendance outcomes over four consecutive 30-day periods were analyzed with regression. Results: The intervention group showed consistently higher rates of drug abstinence and clinic attendance which were significant at the latter two timepoints. Discussion: Smartphone-smartcard platforms can facilitate dissemination of contingency management by surmounting or obviating key barriers to adoption. They appear to be convenient for all stakeholders, are easy to use, and facilitate high-fidelity implementation. Delivering contingency management via a smartphone-smartcard platform produces effects consistent with those observed when the intervention is delivered with substantially costlier and more burdensome in-person procedures.
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Affiliation(s)
- Anthony DeFulio
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | | | - Hayley D Brown
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Shawn Ryan
- BrightView Health, Inc., Cincinnati, OH, United States
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