Contingency Management for Methamphetamine Addiction

Overseen By Nicholas Schumann R Clinical Psychologist

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Queen's Medical Center

Disqualifiers: Active psychosis, Traumatic brain injury, Pregnancy, Prisoners, others

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

Compensation: Varies

Number of Visits: 3

Duration: 12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a program called contingency management, a behavioral therapy designed to help reduce methamphetamine use. It targets trauma patients in Hawaii who use meth and are currently hospitalized. Participants provide urine samples multiple times a week, and those who test negative for meth receive a reward. The study evaluates the effectiveness of this approach and determines the optimal time to start the program. Ideal candidates for the trial are those hospitalized for a trauma injury who use meth at least weekly and have done so for over six months. As an unphased trial, this study offers patients a unique opportunity to contribute to innovative research that could lead to new treatment strategies.

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's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this contingency management intervention is safe for participants?

Research has shown that contingency management is generally safe for individuals overcoming methamphetamine addiction. This method effectively reduces drug use without causing major side effects. It works by rewarding participants for drug-free urine samples, motivating them to stay clean.

For methamphetamine use, studies have not consistently reported any major negative effects with this approach. Participants typically handle the program well, and it aids in maintaining their progress. Additionally, its use in other substance use disorders supports its safety.

Overall, evidence suggests that this treatment is well-tolerated and safe for those dealing with methamphetamine addiction. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about contingency management for methamphetamine addiction because it offers a fresh approach compared to traditional methods like cognitive-behavioral therapy or medication-assisted treatment, which have limited effectiveness for this condition. This technique incentivizes sobriety by providing rewards for negative drug tests, creating a direct and immediate motivation for individuals to remain drug-free. This method not only targets the behavioral aspect of addiction but also provides tangible reinforcement, which can enhance engagement and adherence to treatment. By offering a structured yet flexible approach, it holds promise for improving outcomes in a way that current treatments may not.

What evidence suggests that contingency management is effective for methamphetamine addiction?

Research has shown that contingency management (CM), the treatment under study in this trial, can help reduce methamphetamine use. Studies have found that CM works by providing rewards for drug-free urine tests, motivating individuals to abstain from methamphetamine. It has proven effective in various settings, such as community clinics, and among specific groups, including men who have sex with men (MSM). CM is currently regarded as one of the best treatments for methamphetamine addiction, although it is not widely available in regular healthcare. Early results suggest that CM could play a crucial role in treatment plans for methamphetamine use disorder. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

This trial is for trauma patients in Hawaii who are hospitalized and use methamphetamine. Participants must be willing to undergo urine tests and interviews during their hospital stay and after discharge, up to three times a week for 12 weeks. The study aims to see if starting contingency management (a reward-based treatment) during hospitalization helps with recovery.

Inclusion Criteria

Report at least 4 Diagnostic and Statistical Manual of Mental Disorders 5th Edition, Amphetamine-Type Substance Use Disorder symptoms (at least moderate disease)

Admitted trauma patients

Urine drug screen positive for methamphetamines during the current hospitalization

Exclusion Criteria

Active psychosis (reporting auditory or visual hallucinations)

Patients who are known to be pregnant

Prisoners

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive contingency management intervention during hospitalization and following discharge, with urine analysis conducted on Mondays, Wednesdays, and Fridays

12 weeks

3 visits per week (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including qualitative interviews and Treatment Effectiveness Assessments

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Contingency Management

Trial Overview

The trial is testing the effectiveness of initiating contingency management (CM), which rewards positive behavior, during acute hospitalization for trauma patients with methamphetamine addiction. It compares outcomes like program completion and negative urine samples against another study where CM started post-discharge.

How Is the Trial Designed?

Group I: Contingency management intervention Experimental Treatment 1 Intervention

Intervention is total of 12 weeks. During the hospitalization, participants will be visited by study personnel and will be asked to complete a urine drug screen that will screen for presence of methamphetamine on Mondays/Thursdays or Tuesdays/Fridays (M/Th or T/F). Once discharged, participants will be asked to come into the out patient clinic 2 times per week (M/Th or T/F) to complete a urine drug screen that will screen for presence of methamphetamine. If the specimen is negative for methamphetamine, the participants will be rewarded. Participants will also be asked to complete the Treatment Effectiveness Assessment (TEA) with study personnel.

Who Is Running the Clinical Trial?

Queen's Medical Center

Lead Sponsor

Trials

24

Recruited

4,900+

Published Research Related to This Trial

A pilot study on methamphetamine-dependent individuals indicates that using a reinforcement schedule that increases rewards for consecutive days of abstinence leads to better outcomes.

The study found that resetting the reward magnitude after a positive drug test enhances the effectiveness of contingency management interventions, suggesting a strategic approach to reinforcing abstinence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management: schedule effects. Roll, JM., Shoptaw, S.[2013]

Contingency management has been identified as a potentially effective approach for treating methamphetamine use disorders, as it can enhance treatment outcomes.

The evidence indicates that this method increases the chances of patients providing methamphetamine-free urine samples during treatment, suggesting improved adherence to recovery efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management: an evidence-based component of methamphetamine use disorder treatments. Roll, JM.[2019]

Contingency management (CM) is highly effective in reducing methamphetamine use, as shown in a systematic review of 27 studies, with 20 out of 21 studies reporting positive outcomes for drug abstinence.

CM not only increases drug abstinence but also enhances the use of other treatments and medical services, while significantly reducing risky sexual behaviors among methamphetamine users.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management for the treatment of methamphetamine use disorder: A systematic review. Brown, HD., DeFulio, A.[2021]

Participants in a study of 30 Australians who use methamphetamine expressed positive attitudes towards contingency management (CM) as a treatment for methamphetamine use disorder, indicating its potential effectiveness if implemented in routine care.

There is a need for CM to be flexible in treatment goals and to incorporate digital technologies for remote support, as participants highlighted concerns about initial financial incentives and managing withdrawal symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perspectives and sentiments on contingency management from people who use methamphetamine. Clay, S., Wilkinson, Z., Ginley, M., et al.[2023]

In a study involving 113 participants with methamphetamine use disorders, those who received contingency management alongside standard treatment submitted significantly more negative drug tests and maintained abstinence for longer periods (5 weeks) compared to those receiving only standard treatment (3 weeks).

The use of contingency management, which involved rewards for negative drug tests, shows potential as an effective strategy to enhance treatment outcomes for individuals struggling with methamphetamine addiction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management for the treatment of methamphetamine use disorders. Roll, JM., Petry, NM., Stitzer, ML., et al.[2022]

Contingency management programs, which reward behavior change to reduce stimulant use, are currently the most effective treatment for stimulant use disorder, but they are often hard to access.

A case study of a patient with osteomyelitis showed that adapting these programs to an inpatient hospital setting can significantly improve treatment outcomes for individuals with stimulant use disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Acute Care Contingency Management Program for the Treatment of Stimulant Use Disorder: A Case Report. Bach, P., Garrod, E., Robinson, K., et al.[2022]

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