Contingency Management for Cannabis Use Disorder in Adolescents

Overseen By Jesse D Hinckley, MD, PhD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Colorado, Denver

Must not be taking: Opioids, others

Disqualifiers: Psychosis, Suicide risk, Violence, others

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

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

30 Participants Needed

Trial Summary

What is the purpose of this trial?

This project seeks to learn more about the effects of cannabis use on the endocannabinoid system and endogenous opioid systems in adolescents to address a fundamental gap in knowledge and identify biomarkers that may help distinguish youth who relapse from youth who remain sober.

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, you cannot participate if you have used opioid medications in the past 90 days.

What data supports the effectiveness of the treatment Contingency Management for Cannabis Use Disorder in Adolescents?

Research shows that Contingency Management, which uses rewards to encourage positive behavior like staying off drugs, has been effective in reducing cannabis use among people with mental health disorders. It has also been successful in promoting abstinence from marijuana in individuals with serious mental illness, suggesting it could be a promising approach for adolescents with cannabis use disorder. ^{1 2 3 4 5}

Is contingency management safe for treating cannabis use disorder in adolescents?

Contingency management, which involves rewarding people for achieving their recovery goals, has been studied for various conditions and is generally considered safe. The research does not report any significant safety concerns, but it is important to note that the effectiveness and implementation can vary based on the setting and population. ^{3 4 5 6 7}

How is the Contingency Management treatment for Cannabis Use Disorder in adolescents different from other treatments?

Contingency Management is unique because it uses tangible rewards to encourage positive behavior, like staying drug-free, which can also boost a person's internal motivation to change. Unlike other treatments that might focus on therapy or medication, this approach directly reinforces desired behaviors with incentives. ^{8 9 10 11 12}

Eligibility Criteria

This trial is for adolescents aged 14 to 25 who use cannabis at least twice a week over the past month. It's not open to those using other illicit drugs or opioids recently, with current psychosis, risk of suicide, intellectual deficiencies that affect consent understanding, without internet access for Zoom, or if they're intoxicated during evaluation.

Inclusion Criteria

I am between 14 and 25 years old.

You have been using cannabis at least two times a week for the last month.

Exclusion Criteria

Refusal of valid written consent,

You are currently experiencing a mental health condition called psychosis.

You have used opioid medications for medical or recreational reasons in the past 90 days.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Measurement

Measure endocannabinoid and endogenous opioid levels in adolescents who use cannabis regularly and those who do not

1 week

1 visit (in-person)

Abstinence Monitoring

Characterize circulating eCB and endorphin levels during abstinence and collect data on cannabis craving

6 weeks

Weekly visits (in-person)

Follow-up

Participants are monitored for changes in eCB and endorphin levels after natural resumption of cannabis use

1 week

1 visit (in-person)

Treatment Details

Interventions

• Contingency Management

Trial Overview The study is exploring how regular cannabis use affects young people's natural cannabinoid and opioid systems. By monitoring these biological markers in adolescents with Cannabis Use Disorder, researchers aim to identify patterns that could predict relapse or sustained sobriety.

Participant Groups

Group I: Contingency Management Experimental Treatment 1 Intervention

Abstinence will be rewarded following a contingency management (CM) payment scale.

Contingency Management is already approved in United States, European Union for the following indications:

Approved in United States as Contingency Management for:

• Substance Use Disorders
• Stimulant Use Disorder
• Methamphetamine Use Disorder

Approved in European Union as Contingency Management for:

• Substance Use Disorders
• Addiction Treatment

Who Is Running the Clinical Trial?

University of Colorado, Denver

Lead Sponsor

Trials

1,842

Recruited

3,028,000+

Colorado Clinical & Translational Sciences Institute

Collaborator

Trials

21

Recruited

1,400+

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]

Prize-based abstinence incentives combined with standard treatment did not show significant differences in effectiveness for patients with varying treatment histories, indicating that the incentives may be equally beneficial regardless of prior treatment experience.

The study involved treatment-seeking outpatients and assessed outcomes like the longest period of abstinence and negative urine drug screens, suggesting that these incentives can be a consistent motivational tool across diverse patient backgrounds.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of motivational incentives in stimulant abusing outpatients with different treatment histories. Killeen, T., Carter, R., Copersino, M., et al.[2019]

Contingency management (CM) has been shown to effectively reduce cannabis use and promote abstinence in individuals with comorbid cannabis use disorder and mental health disorders, particularly those with psychotic-spectrum or major depressive disorders.

The review included six studies, indicating a need for more extensive longitudinal research with larger sample sizes and diverse psychiatric populations to better understand the long-term effects of CM.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency Management for Treatment of Cannabis Use Disorder in Co-Occurring Mental Health Disorders: A Systematic Review. Rodas, JD., Sorkhou, M., George, TP.[2023]

A study involving 18 adults with serious mental illness showed that providing monetary incentives significantly increased the number of negative urine tests for marijuana use compared to baseline conditions.

The results suggest that using financial rewards can effectively encourage abstinence from marijuana among individuals with serious mental health issues, indicating the potential for contingency-management strategies in reducing substance abuse.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingent reinforcement of marijuana abstinence among individuals with serious mental illness: a feasibility study. Sigmon, SC., Steingard, S., Badger, GJ., et al.[2019]

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]

Contingency management, which rewards individuals for achieving recovery goals, is proven to be highly effective for treating opioid use disorder but remains underutilized in clinical practice due to various concerns.

Barriers to implementing contingency management include ethical and economic issues, but leveraging technology and fostering partnerships between academia and industry could enhance its adoption and improve treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rewarding recovery: the time is now for contingency management for opioid use disorder. Proctor, SL.[2022]

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]

Contingency management (CM) has been shown to effectively improve outcomes for substance-abusing adolescents, with a study involving 86 participants who selected from 1,739 activities across various goal areas.

The adolescents completed an average of 13 out of 20 chosen activities, achieving a completion rate of 64%, indicating that activity incentive programs can be a feasible and effective approach for promoting abstinence and treatment adherence in this age group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingent reinforcement of personal goal activities for adolescents with substance use disorders during post-residential continuing care. Godley, SH., Godley, MD., Wright, KL., et al.[2021]

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]

Contingency management (CM) is an effective psychosocial treatment for substance use disorders that uses tangible rewards to reinforce drug-negative behaviors, showing strong efficacy based on behavioral analysis principles.

CM not only provides external rewards but may also enhance a patient's intrinsic motivation to change their substance use behavior, suggesting broader applications for this intervention beyond substance use disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motivation and Contingency Management Treatments for Substance Use Disorders. Walter, KN., Petry, NM.[2016]

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 systematic review of 12 randomized controlled trials involving 1654 adults found that adding cognitive-behavioral therapy (CBT) or motivational enhancement therapy (MET) to contingency management (CM) did not improve rates of abstinence from substance use at the end of treatment or during follow-up.

The analysis showed no significant benefits in secondary outcomes, such as self-reported days of substance use, indicating that CM alone is as effective as when combined with these psychotherapeutic interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis. Sheridan Rains, L., Steare, T., Mason, O., et al.[2021]

References

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

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

2. England pubmed.ncbi.nlm.nih.gov

Effectiveness of motivational incentives in stimulant abusing outpatients with different treatment histories. [2019]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Contingency Management for Treatment of Cannabis Use Disorder in Co-Occurring Mental Health Disorders: A Systematic Review. [2023]

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

Contingent reinforcement of marijuana abstinence among individuals with serious mental illness: a feasibility study. [2019]

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

Examining implementation of contingency management in real-world settings. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Rewarding recovery: the time is now for contingency management for opioid use disorder. [2022]

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

Using prize-based incentives to enhance daily interactive voice response (IVR) compliance: a feasibility study. [2021]

8. England pubmed.ncbi.nlm.nih.gov

Contingent reinforcement of personal goal activities for adolescents with substance use disorders during post-residential continuing care. [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. Germany pubmed.ncbi.nlm.nih.gov

Motivation and Contingency Management Treatments for Substance Use Disorders. [2016]

11. New Zealand 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. [2020]

12. England pubmed.ncbi.nlm.nih.gov

Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis. [2021]