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

59 Participants Needed

Trial Summary

What is the purpose of this trial?

The proposed work will investigate changes in brain signaling and cognitive functioning that support recovery from addiction, as well as use of pretreatment neurocognitive functioning to inform substance use treatment planning. Substance use disorders are prevalent amongst Veterans. Cocaine addiction, in particular, has been shown to complicate treatment of other high priority behavioral health problems in the Veteran population (e.g., PTSD, opioid addiction). While there are currently no approved medications to support recovery from cocaine addiction, research indicates that Contingency Management (CM) - a behavioral intervention for cocaine users - can be effective. However, individual responses are variable and long-term benefits are limited. This CDA will test a new model of how CM works by examining brain-based predictors and indicators of treatment response. Results will have immediate implications for measurement-based implementation of existing CM variants within the VA, supporting access to the version of CM that is best aligned with each Veteran's needs.

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.

What data supports the effectiveness of the treatment Prize-Based Contingency Management for Cocaine Use Disorder?

Research shows that contingency management, which involves giving rewards for staying drug-free, is effective in helping people with cocaine use disorder reduce their drug use and stay in treatment longer. Studies found that both cash and prize-based incentives can lead to more abstinence compared to standard treatment alone. ^{1 2 3 4 5}

Is prize-based contingency management safe for humans?

Research indicates that prize-based contingency management is safe for humans, as it does not increase gambling behavior and is effective in helping people abstain from cocaine use without causing harm. ^{1 4 6 7 8}

How does Prize-Based Contingency Management treatment differ from other treatments for cocaine use disorder?

Prize-Based Contingency Management is unique because it uses a system of rewards, like chances to win prizes, to encourage abstinence from cocaine, making it appealing and effective for individuals with or without gambling habits. This approach differs from traditional treatments that may not incorporate such motivational incentives. ^{1 3 8 9 10}

Research Team

Sarah E. Forster, PhD

Principal Investigator

VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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 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]

References

1. Ireland pubmed.ncbi.nlm.nih.gov

Income does not affect response to contingency management treatments among community substance abuse treatment-seekers. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

A preliminary investigation of schedule parameters on cocaine abstinence in contingency management. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users in Brazil: A randomized controlled trial. [2018]

4. England pubmed.ncbi.nlm.nih.gov

What do we get for our money? Cost-effectiveness of adding contingency management. [2013]

5. United States pubmed.ncbi.nlm.nih.gov

Contingency management in cocaine abusers: a dose-effect comparison of goods-based versus cash-based incentives. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Use of contingency contracts in specialty clinics for cocaine abuse. [2013]

7. United States pubmed.ncbi.nlm.nih.gov

Contingency Management Abstinence Incentives: Cost and Implications for Treatment Tailoring. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Prize-based contingency management is efficacious in cocaine-abusing patients with and without recent gambling participation. [2021]

9. England pubmed.ncbi.nlm.nih.gov

Prize reinforcement contingency management for treating cocaine users: how low can we go, and with whom? [2018]

10. United States pubmed.ncbi.nlm.nih.gov

Vouchers versus prizes: contingency management treatment of substance abusers in community settings. [2016]