Contingency Management for Cocaine Use Disorder

(WRAP Trial)

Overseen By Stuart R Steinhauer, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Severe TBI, Seizure disorder, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how different prize-based approaches can aid Veterans in recovering from cocaine addiction. By testing two types of Contingency Management (CM), where participants earn prizes for meeting treatment goals, researchers aim to determine which method is most effective and why. The study will also examine how brain activity and thinking skills might predict and influence treatment success. Veterans who have used cocaine in the past 60 days and wish to quit or reduce use may be suitable candidates for this trial. As an unphased trial, this study offers Veterans the chance to contribute to groundbreaking research that could shape future addiction treatments.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that both Voucher Prize-Based Contingency Management (VoucherPBCM) and Tangible Prize-Based Contingency Management (TangiblePBCM) are generally well-accepted treatments for cocaine use disorder. These methods have proven effective in reducing drug use, including cocaine.

Importantly, these treatments do not involve medications, eliminating concerns about drug-related side effects. Instead, they use rewards to encourage positive behavior, such as staying drug-free, making them a safe option for many people.

Studies have not reported any negative side effects directly linked to these prize-based methods, suggesting they are safe to use as part of a treatment plan. However, since everyone is different, discussing any concerns with a healthcare provider is always best. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using Prize-Based Contingency Management (PBCM) for treating cocaine use disorder because it offers a unique approach that significantly differs from traditional methods like cognitive-behavioral therapy (CBT) and pharmacotherapy, which have mixed results. PBCM, particularly in its Voucher and Tangible forms, directly incentivizes positive behavior by providing tangible rewards, such as vouchers or prizes, for staying drug-free. This method taps into the brain's reward system, offering immediate gratification and reinforcing abstinence more effectively. By tailoring rewards to individual preferences and making them visible and accessible, these treatments aim to motivate patients in a novel and engaging way, potentially leading to better outcomes than current options.

What evidence suggests that this trial's treatments could be effective for cocaine use disorder?

Research has shown that Contingency Management (CM) effectively treats cocaine addiction. In this trial, participants will join one of two treatment arms: Voucher Prize-Based Contingency Management (VoucherPBCM) or Tangible Prize-Based Contingency Management (TangiblePBCM). Studies have found that both Voucher and Tangible Prize-Based CM reduce drug use by rewarding individuals with prizes or vouchers for staying drug-free. These rewards motivate individuals to remain drug-free for longer periods. Prize-based CM, in particular, has helped people quit using drugs like cocaine, opioids, and alcohol. While individual results may vary, evidence supports CM as an effective method for recovering from cocaine addiction. ^{1 4 6 7 8}

Who Is on the Research Team?

Sarah E. Forster, PhD

Principal Investigator

VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

Are You a Good Fit for This Trial?

This trial is for military veterans who have used cocaine in the past 60 days and meet criteria for Cocaine Use Disorder. They must want to stop or reduce cocaine use, have good vision and hearing (with aids if needed). It's not open to those with severe cognitive issues, pregnant or breastfeeding women, people with certain neurological conditions, or unstable health.

Inclusion Criteria

Cocaine Use Within Past 60 Days

My vision is normal, or corrected to normal with glasses or contacts.

You must have normal hearing.

Exclusion Criteria

I do not have any severe or unstable health or mental conditions.

In Ongoing Residential Treatment or Imminently Expected to Enter Residential Treatment During the Study Interval at Time of Screening

You are currently pregnant or breastfeeding.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Contingency Management (CM) treatment, either VoucherPBCM or TangiblePBCM, for cocaine abstinence with neurocognitive assessments

12 weeks

Weekly sessions

Follow-up

Participants are monitored for maintenance of treatment gains and abstinence

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Prize-Based Contingency Management
• Treatment As Usual Outpatient Substance Use Treatment

Trial Overview The study tests how a behavioral intervention called Contingency Management helps recovery from cocaine addiction by rewarding abstinence. It also looks at brain signaling and cognitive function changes during treatment. The goal is to tailor this approach to each veteran's needs.

How Is the Trial Designed?

Group I: Voucher Prize-Based Contingency Management (VoucherPBCM) Experimental Treatment 2 Interventions

For participants assigned to VoucherPBCM, prize draws resulting in one or more small, large, or jumbo wins will be reinforced with VA Canteen vouchers in the specified incentive range (i.e., small, large, or jumbo).

Group II: Tangible Prize-Based Contingency Management (TangiblePBCM) Experimental Treatment 2 Interventions

For participants assigned to TangiblePBCM, prize draws resulting in one or more small, large, or jumbo wins will result in access to a prize cabinet stocked with small, medium, large, and jumbo financial incentive items. Medium incentive items are included for selection in the event that a patient draws several small prize slips on the same day and are considered equivalent to 4 small prizes. Selection of specific prize items will be informed by patient preference and items will be restocked at least every 2 weeks. The prize cabinet will be open during TangiblePBCM sessions such that prize items are readily visible. Selection of prizes, maintenance of the prize cabinet, and policies regarding prize redemption will follow published guidance on administration of TangiblePBCM within the context of research protocols.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

In a 16-week study involving 12 cocaine-dependent methadone patients, cash-based incentives of $50 and $100 significantly increased short-term cocaine abstinence compared to a control condition with no incentives.

The study found that cash-based incentives did not lead to increased cocaine use after receiving the incentives, suggesting they are a safe option for improving treatment outcomes in substance abuse interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management in cocaine abusers: a dose-effect comparison of goods-based versus cash-based incentives. Vandrey, R., Bigelow, GE., Stitzer, ML.[2022]

A study involving 120 cocaine-abusing outpatients showed that a low-cost prize reinforcement contingency management (CM) intervention significantly increased abstinence rates, especially in patients receiving up to $240 in potential rewards compared to standard treatment.

Patients who started treatment with positive urine tests responded best to the CM intervention, indicating that the effectiveness of prize reinforcement may depend on the severity of the patient's condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prize reinforcement contingency management for treating cocaine users: how low can we go, and with whom? Petry, NM., Tedford, J., Austin, M., et al.[2018]

In a study of 255 substance users undergoing outpatient treatment, participants who were drug-free at the start (baseline negative) earned significantly more in contingency management (CM) incentives compared to those who were using drugs (baseline positive), with median prizes of $237 versus $44, respectively.

The findings suggest that tailoring CM interventions based on a participant's drug use status at treatment entry could enhance the effectiveness of abstinence-focused programs, as the majority of incentive expenditures were directed towards those who were already abstinent.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency Management Abstinence Incentives: Cost and Implications for Treatment Tailoring. Cunningham, C., Stitzer, M., Campbell, AN., et al.[2019]

In a study involving 142 outpatients with cocaine or heroin dependence, both voucher and prize-based contingency management (CM) interventions led to longer treatment retention and greater durations of confirmed abstinence compared to standard treatment.

While there were no significant differences in abstinence rates at 6- and 9-month follow-ups, the duration of abstinence achieved during treatment was the strongest predictor of continued abstinence after treatment ended.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vouchers versus prizes: contingency management treatment of substance abusers in community settings. Petry, NM., Alessi, SM., Marx, J., et al.[2016]

In a study involving 34 individuals with Cocaine Use Disorder, larger fixed incentives for providing negative urine samples led to faster and more effective abstinence compared to smaller incentives.

The type of incentive structure (escalating and resetting vs. fixed) did not significantly impact the overall effectiveness, suggesting that the magnitude of the incentive is more crucial for promoting abstinence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A preliminary investigation of schedule parameters on cocaine abstinence in contingency management. Regnier, SD., Strickland, JC., Stoops, WW.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2937065/

Prize-based contingency management is efficacious in ... Randomized trials have established the efficacy of prize CM in reducing drug use across a variety of substance abusing populations and settings (Alessi, Hanson, ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3709247/

Prize reinforcement contingency management for treating ... This study evaluated the efficacy of a low-cost, prize reinforcement contingency management (CM) intervention for reducing cocaine use. Community-based ...

3. jamanetwork.com jamanetwork.com/journals/jamapsychiatry/fullarticle/208958

Effect of Prize-Based Incentives on Outcomes in Stimulant ... The efficacy of CM has been demonstrated in opioid-, marijuana-, alcohol-, and cocaine-dependent patients. In treating cocaine dependence, many CM studies ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S2451865421000971

Rationale and design for the ways of rewarding abstinence ... This trial aims to advance precision implementation of Prize-Based Contingency Management (PBCM) for cocaine use disorder.

5. health.ny.gov health.ny.gov/health_care/medicaid/ebbrac/2025/docs/2025-04-02_contingency_mgmt_sud_rpt.pdf

Contingency Management for Stimulant Use Disorder Health ... predict how veterans with cocaine use disorder respond to tangible prize-based CM and abstract. (voucher) prize-based CM.145 This trial has enrolled 59 ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4203362/

Prize-based Contingency Management for the Treatment of ... Both VBRT and PB procedures have shown good efficacy in clinical trials, with extensive empirical evidence that VBRT is efficacious for establishing abstinence ...

7. library.samhsa.gov library.samhsa.gov/sites/default/files/contingency-management-advisory-pep24-06-001.pdf

contingency-management-advisory-pep24-06-001.pdf Prize-based CM can be used to provide a similar outcome to voucher-based CM, but with the possibility of a smaller average outlay for incentives (Petry et ...

8. researchgate.net researchgate.net/publication/45406058_Prize-based_contingency_management_is_efficacious_in_cocaine-abusing_patients_with_and_without_recent_gambling_participation

Prize-based contingency management is efficacious in ... Substantial research over the last few decades has shown that CM significantly reduces drug use, including; public alcohol use (Miller, 1975; ...