600 Participants Needed

Incentive-Based Intervention for Substance Abuse Disorders

Recruiting at 2 trial locations
MW
EW
BB
GD
KP
AZ
RD
Overseen ByRebecca Dizon-Ross, PhD
Age: 18+
Sex: Any
Trial Phase: Phase 2
Sponsor: Aurora Health Care
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Prior Safety DataThis treatment has passed at least one previous human trial

Trial Summary

What is the purpose of this trial?

Combatting the rise of the opioid epidemic is a central challenge of U.S. health care policy. A promising approach for improving welfare and decreasing medical costs of people with substance abuse disorders is offering incentive payments for healthy behaviors. This approach, broadly known as "contingency management" in the medical literature, has repeatedly shown to be effective in treating substance abuse. However, the use of incentives by treatment facilities remains extremely low. Furthermore, it is not well understood how to design optimal incentives to treat opioid abuse. This project will conduct a randomized evaluation of two types of dynamically adjusting incentive schedules for people with opioid use disorders or cocaine use disorders: "escalating" schedules where incentive amounts increase with success to increase incentive power, and "de-escalating" schedules where incentive amounts decrease with success to improve incentive targeting. Both schemes are implemented with a novel "turnkey" mobile application, making them uniquely low-cost, low-hassle, and scalable. Effects will be measured on abstinence outcomes, including longest duration of abstinence and the percentage of negative drug tests. In combination with survey data, variation from the experiment will shed light on the barriers to abstinence more broadly and inform the understanding of optimal incentive design.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on using incentives to encourage abstinence from opioids, cocaine, or methamphetamine, but does not mention other medications.

What data supports the effectiveness of the treatment App-Based Contingency Management for Substance Abuse Disorders?

Research shows that contingency management (CM), which uses rewards to encourage positive behavior, is effective in promoting drug abstinence. A study found that using a smartphone-smartcard platform for CM led to higher rates of drug abstinence and better attendance at counseling appointments. Additionally, CM has been shown to be effective in treating various substance use disorders, including opioid and cocaine use.12345

Is incentive-based intervention for substance abuse disorders safe for humans?

The research on incentive-based interventions, like contingency management, shows they are generally safe for humans. These interventions use rewards to encourage positive behaviors, such as drug abstinence, and have been successfully implemented in various settings without significant safety concerns.12346

How is the app-based contingency management treatment different from other treatments for substance abuse disorders?

The app-based contingency management treatment is unique because it uses mobile technology to deliver rewards for positive behaviors, like staying drug-free, which can be especially helpful for people in remote areas. This approach makes it easier to provide immediate and personalized incentives, unlike traditional methods that may not be as accessible or adaptable.12357

Research Team

AZ

Ariel Zucker, PhD

Principal Investigator

University of California Santa Cruz

Eligibility Criteria

This trial is for adults over 18 who have used opioids, cocaine, or methamphetamine non-medically in the last 21 days. Participants must be currently receiving some form of substance abuse treatment and meet specific medical criteria for substance use disorders. They need to have a smartphone with a data plan, an email they can access on their phone, and be willing to download and use the DynamiCare app.

Inclusion Criteria

Have an email and can access it from their smartphone
I am currently in a substance abuse treatment program.
Used non-medical opioids, cocaine, and/or methamphetamine within the last 21 days
See 5 more

Exclusion Criteria

Have evidence of active (non-substance related) psychosis that might impair participation as determined by the PI
I do not have severe cognitive issues that require a legal guardian.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive incentives for drug-negative saliva tests using the DynamiCare app, with varying incentive schedules (escalating, de-escalating, constant).

12 weeks
Remote monitoring via app

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

  • App-Based Contingency Management
  • Sham Control
Trial OverviewThe study tests two incentive-based approaches using an app called DynamiCare to promote abstinence from drug use among individuals with opioid or cocaine addiction. One approach increases rewards over time (escalating), while the other decreases them (de-escalating) as participants demonstrate continued abstinence.
Participant Groups
7Treatment groups
Experimental Treatment
Active Control
Group I: Escalating LowExperimental Treatment1 Intervention
Participants will have access to the DynamiCare app. Through the app, participants will receive incentive amounts for drug negative saliva tests. Incentive amounts increase with every negative drug test up to a ceiling and "reset" to the lowest amount when a test is positive or missed. The "Low" group will receive incentives worth $2-$8.
Group II: Escalating HighExperimental Treatment1 Intervention
Participants will have access to the DynamiCare app. Through the app, participants will receive incentive amounts for drug negative saliva tests. Incentive amounts increase with every negative drug test up to a ceiling and "reset" to the lowest amount when a test is positive or missed. The "High" group will receive incentives worth $4-$16.
Group III: De-Escalating LowExperimental Treatment1 Intervention
Participants will have access to the DynamiCare app. Through the app, participants will receive incentive amounts for drug negative saliva tests. Incentive amounts increase with every positive drug tests (up to a ceiling), and decrease by the same increment with every negative drug test (down to a floor). The "Low" group will receive incentives worth $6-12.
Group IV: De-Escalating HighExperimental Treatment1 Intervention
Participants will have access to the DynamiCare app. Through the app, participants will receive incentive amounts for drug negative saliva tests. Incentive amounts increase with every positive drug tests (up to a ceiling), and decrease by the same increment with every negative drug test (down to a floor). The "High" group will receive incentives worth $10-$20.
Group V: Constant LowExperimental Treatment1 Intervention
In the Constant groups, incentive amounts will remain unchanged across time. The "Low" group will receive incentives worth $8 every test.
Group VI: Constant HighExperimental Treatment1 Intervention
In the Constant groups, incentive amounts will remain unchanged across time. The "High" group will receive incentives worth $16.
Group VII: ControlActive Control1 Intervention
Participants in this group will have access to the DynamiCare app; however, no behavioral incentives will be provided to this group.

Find a Clinic Near You

Who Is Running the Clinical Trial?

Aurora Health Care

Lead Sponsor

Trials
46
Recruited
16,400+

Wake Forest University Health Sciences

Lead Sponsor

Trials
1,432
Recruited
2,506,000+

University of California Santa Cruz

Lead Sponsor

Trials
7
Recruited
2,300+

University of Chicago

Collaborator

Trials
1,086
Recruited
844,000+

University of California, Santa Cruz

Collaborator

Trials
5
Recruited
2,100+

Rogers Behavioral Health

Collaborator

Trials
3
Recruited
1,200+

Findings from Research

The integrated smartphone-smartcard platform significantly improved counseling appointment attendance and drug abstinence rates among 85 adults with opioid use disorder over a four-month period, showing a 9.6%-18.0% increase in attendance and an odds ratio of 4.84 for drug abstinence compared to matched controls.
Participants overwhelmingly found the platform acceptable, indicating that this technology could help overcome barriers to the adoption of contingency management (CM) interventions in treatment settings.
A smartphone-smartcard platform for contingency management in an inner-city substance use disorder outpatient program.DeFulio, A., Rzeszutek, MJ., Furgeson, J., et al.[2021]
A survey of 214 substance use treatment providers revealed that while many clinics are using reward programs, they often do not follow effective practices recommended by research, such as providing higher reward amounts or immediate reinforcement.
Providers with more extensive training in contingency management (CM) were more likely to implement effective strategies, suggesting that better training could improve the quality of reward-based interventions in real-world settings.
Examining implementation of contingency management in real-world settings.Rash, CJ., Alessi, SM., Zajac, K.[2021]
Contingency management (CM) is an effective behavior-modification method for treating substance-use disorders (SUDs), and this review analyzed 31 studies to explore its advancements and applications.
Emerging technologies, such as mobile delivery systems and new biomarkers, can enhance CM's effectiveness by personalizing interventions and making them accessible to underserved populations, particularly in hard-to-reach areas.
A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies.McPherson, SM., Burduli, E., Smith, CL., et al.[2020]

References

A smartphone-smartcard platform for contingency management in an inner-city substance use disorder outpatient program. [2021]
Examining implementation of contingency management in real-world settings. [2021]
A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies. [2020]
A preliminary investigation of schedule parameters on cocaine abstinence in contingency management. [2023]
Home-Based Contingency Management Delivered by Community Health Workers to Improve Alcohol Abstinence: A Randomized Control Trial. [2020]
Internet-based self-tailored deposit contracts to promote smoking reduction and abstinence. [2018]
Using prize-based incentives to enhance daily interactive voice response (IVR) compliance: a feasibility study. [2021]