Incentive-Based Intervention for Substance Abuse Disorders

Recruiting at 2 trial locations

Overseen By Rebecca Dizon-Ross, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Aurora Health Care

Disqualifiers: Active psychosis, Cognitive impairment, others

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

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

600 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores new ways to assist individuals with opioid, cocaine, or methamphetamine use disorders by using incentive payments to encourage negative drug tests. It tests various methods of distributing these incentives, such as adjusting the reward based on test results, through a mobile app called DynamiCare. This approach is known as App-Based Contingency Management. The goal is to identify the most effective way to support individuals in remaining drug-free and to understand the barriers to abstinence. Suitable participants have recently used drugs like opioids or cocaine and have access to a smartphone. As an unphased trial, this study provides a unique opportunity to contribute to innovative research that could shape future treatments for substance use disorders.

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 prior data suggests that this incentive-based intervention is safe for treating substance abuse disorders?

Research has shown that app-based treatments like DynamiCare are generally safe for people with substance use disorders. Studies have found that managing rewards through a smartphone app can improve treatment outcomes. Importantly, no significant reports of harm or negative effects have emerged from using the app itself.

The treatment provides rewards through the app for drug-free tests. This digital method is affordable and practical for many people. Although this approach is relatively new, current data suggests it is well-tolerated and safe. So far, studies have not identified any major safety concerns for participants using these types of rewards. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the app-based contingency management treatments because they offer a unique approach to tackling substance abuse disorders. Unlike traditional treatments like counseling, medication-assisted treatment, or support groups, these app-based solutions use immediate incentives to encourage drug-free behavior. They work by providing financial rewards through the DynamiCare app for negative drug tests, which could increase motivation and adherence to treatment. The flexibility in incentive structures—such as constant, escalating, or de-escalating rewards—allows for personalized strategies that might boost effectiveness. This approach could transform how we support individuals in recovery by integrating technology and behavioral economics.

What evidence suggests that this trial's treatments could be effective for substance abuse disorders?

Research has shown that using apps to manage rewards effectively treats substance use disorders. In over 100 studies, this method has consistently helped people reduce drug use. In this trial, participants will use the DynamiCare app to test themselves easily and earn rewards for negative drug results. Some participants will receive varying incentive amounts based on their assigned group, while others will be in a control group without behavioral incentives. Studies have found that using this app alongside medication-assisted treatment leads to better outcomes in clinical settings. Most users find the app easy to use and believe it helps them reduce substance use. This approach not only supports staying drug-free but is also user-friendly and accessible to many people. ^{1 2 6 7 8}

Who Is on the Research Team?

Mercedes Robaina, PhD

Principal Investigator

Advocate Aurora Behavioral Health Services

Are You a Good Fit for This Trial?

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

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

Interventions

• App-Based Contingency Management
• Sham Control

Trial Overview The 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.

How Is the Trial Designed?

Group I: Escalating Low Experimental Treatment 1 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 High Experimental Treatment 1 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 Low Experimental Treatment 1 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 High Experimental Treatment 1 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 Low Experimental Treatment 1 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 High Experimental Treatment 1 Intervention

In the Constant groups, incentive amounts will remain unchanged across time. The "High" group will receive incentives worth $16.

Group VII: Control Active Control 1 Intervention

Participants in this group will have access to the DynamiCare app; however, no behavioral incentives will be provided to this group.

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 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+

University of California Santa Cruz

Collaborator

Trials

7

Recruited

2,300+

Published Research Related to This Trial

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.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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]

The study found that using a prize-based contingency management approach significantly increased compliance with daily interactive voice response (IVR) calls, with participants in the prize group being 4.7 times more likely to call than those in the fixed dollar group.

Higher rates of IVR calls were linked to better outcomes in cocaine abstinence, suggesting that engaging participants through innovative reward systems can enhance treatment effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using prize-based incentives to enhance daily interactive voice response (IVR) compliance: a feasibility study. Lindsay, JA., Minard, CG., Hudson, S., et al.[2021]

In a 12-week study involving 161 adults with alcohol dependence, higher-magnitude contingency management (CM-H) significantly reduced the average number of positive breath samples, indicating less alcohol use during the intervention.

Participants in the CM-H group had a higher rate of abstinence during follow-up, suggesting that home-based CM with sufficient incentives can effectively support long-term abstinence from alcohol.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Home-Based Contingency Management Delivered by Community Health Workers to Improve Alcohol Abstinence: A Randomized Control Trial. Jirapramukpitak, T., Pattanaseri, K., Chua, KC., et al.[2020]

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]

Internet-based deposit contracts for smoking cessation were effective in increasing the number of breath samples meeting the carbon monoxide criterion, with 47% success in Experiment 1 and 41.5% in Experiment 2, compared to virtually no success during baseline measurements.

Participants found the deposit contract interventions acceptable and feasible, indicating a positive reception that could support further research into their long-term effectiveness for smoking cessation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-based self-tailored deposit contracts to promote smoking reduction and abstinence. Jarvis, BP., Dallery, J.[2018]

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.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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]

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.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining implementation of contingency management in real-world settings. Rash, CJ., Alessi, SM., Zajac, K.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8197772/

Digital delivery of a contingency management intervention ... The DynamiCare Health smartphone app delivers a contingency management intervention for substance use disorder consisting of remote self-testing for alcohol ( ...

2. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2827185

Smartphone App–Based Contingency Management and ... These findings suggest that adding app-based contingency management to MOUD is associated with better treatment outcomes in clinical settings.

3. dynamicarehealth.com dynamicarehealth.com/contingency-management

Contingency Management Contingency Management is one of the most effective and evidence-based psychosocial treatments for substance use disorders. In over 100 randomized ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S2772724623000100

Feasibility study findings of an app-based contingency ... All participants (100%) found the app easy to use and stated that it helped them reduce their alcohol use. Eleven (91.7%) would recommend the app as an adjunct ...

5. clinicaltrials.gov clinicaltrials.gov/study/NCT04162132

Contingency Management Using Smartphone App in ... The purpose of this research study was to test the acceptance and efficacy of a smartphone app (DynamiCare Rewards) for patients with substance use disorder ( ...

6. dynamicarehealth.com dynamicarehealth.com/cm-reports

Contingency Management Reports — DynamiCare Health The following free reports have been developed by DynamiCare and are being provided to the public for education on the contingency management model.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11612830/

Smartphone App–Based Contingency Management and ... These findings suggest that adding app-based contingency management to MOUD is associated with better treatment outcomes in clinical settings.

8. clinicaltrials.gov clinicaltrials.gov/study/NCT05521854

Contingency Management for Drug Use: Does Age Matter? The OVERALL AIM is to assess whether app-based incentives are effective for older adults and to quantify the associations between age and both the efficacy ...