Contingency Management for Substance Use Disorders

Overseen By Mary Lonergan-Cullum, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Minnesota

Must be taking: Buprenorphine-naloxone

Must not be taking: Amphetamines

Disqualifiers: Dementia, Development disabilities, 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: 6

Duration: 3 months

42 Participants Needed

Trial Summary

What is the purpose of this trial?

Contingency management (CM) is a behavioral intervention that involves incentivizing participants for target behaviors in a clinical setting. When applied to the treatment of substance use disorders, it has demonstrated efficacy in reducing the number of urine toxicology screens positive for illicit substances and increased engagement in treatment programs. However, there is a need to translate CM treatment to primary care settings. This study will implement and assess a CM program for patients with opioid use disorder, with or without comorbid stimulant use disorder, initiating outpatient addiction medicine services at a family medicine residency clinic. Eligible patients will earn monetary incentives for attending addiction medicine appointments and abstaining from substances during outpatient treatment. Data gathered from this pilot program will be used to improve patient outcomes, treatment, and retention for persons receiving medications for opioid use disorder (MOUDs) in a primary care setting.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you must have an active prescription for buprenorphine-naloxone (Suboxone) to participate.

What data supports the effectiveness of the treatment Contingency Management for Substance Use Disorders?

Research shows that Contingency Management, which uses rewards like vouchers or prizes, helps people stay in treatment longer and achieve longer periods without using drugs. This approach has been effective in promoting abstinence in individuals with cocaine or heroin dependence. ^{1 2 3 4 5}

Is Contingency Management safe for humans?

Research suggests that Contingency Management, including cash-based incentives, is generally safe for humans. Studies have shown that even high-value incentives do not increase substance use, indicating a favorable safety profile. ^{1 3 4 5 6}

How is the Contingency Management treatment different from other treatments for substance use disorders?

Contingency Management is unique because it uses tangible rewards, like vouchers or prizes, to encourage abstinence from substance use, which is different from other treatments that may not involve direct incentives. This approach focuses on positive reinforcement to motivate behavior change. ^{1 3 7 8 9}

Research Team

Robert Levy, MD

Principal Investigator

University of Minnesota

Eligibility Criteria

This trial is for adults over 18 with Opioid Use Disorder and/or Stimulant Use Disorder who recently started opioid addiction treatment at Broadway Family Medicine. They must be prescribed buprenorphine-naloxone (Suboxone). Those with dementia, developmental disabilities, or low cognitive function, or those on amphetamines can't join the abstinence-based part but may join the attendance-only part.

Inclusion Criteria

I am currently prescribed Suboxone.

I am 18 years old or older.

Recently initiated medications for opioid use disorder (MOUDs) at Broadway Family Medicine (BFM), within 2 weeks of recruitment

Exclusion Criteria

Prescription for an amphetamine would exclude patients from the abstinence-based CM, but they could participate in the attendance-only CM

Dementia, development disabilities, or cognitive functioning that is too low to participate in study measures, as determined by chart review and consultation with overseeing physician.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive contingency management (CM) intervention, earning incentives for attending appointments and abstaining from substances

3 months

Regular follow-up appointments as per treatment plan

Follow-up

Participants are monitored for safety and effectiveness after treatment

9 months

Follow-up visits at 6 and 12 months

Treatment Details

Interventions

• Contingency Management

Trial Overview The study tests Contingency Management (CM) in a primary care setting. CM rewards patients financially for attending addiction medicine appointments and staying substance-free. The goal is to see if this approach helps people stick with their outpatient treatment programs better.

Participant Groups

Group I: Attendance-only CM Experimental Treatment 1 Intervention

Patients in this arm complete an appointments with his or her primary care provider (PCP) or member of the PCP's microteam . These appointments must be initiated by the PCP/microteam in accordance with the patient's treatment plan for regular follow-up appointments.

Group II: Attendance + abstinence CM Experimental Treatment 1 Intervention

Patients who test stimulant-positive during the initial urine drug screen (UDS) at their intake visit will be invited to additionally enroll in the abstinence CM schedule. All of the attendance-only CM rules described previously will apply to patients in the attendance + abstinence program.

Group III: Treatment as usual (TAU) Active Control 1 Intervention

These patients will not be assigned to the CM programs, but will be invited to complete study measures at the same time points: baseline, 3-months, 6-months, and 12-months.

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 Minnesota

Lead Sponsor

Trials

1,459

Recruited

1,623,000+

Findings from Research

In a study involving 74 cocaine-dependent methadone outpatients over 12 weeks, both voucher and prize-based contingency management (CM) interventions led to longer durations of abstinence compared to standard treatment.

The study found no significant differences in outcomes between the voucher and prize systems, indicating that both methods are effective in promoting abstinence during treatment, which is linked to better long-term recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. Petry, NM., Alessi, SM., Hanson, T., et al.[2021]

The study involved 103 outpatients with substance abuse issues and found that prize-based contingency management (CM) significantly increased the longest duration of sustained abstinence (LDA) compared to standard treatment, indicating its effectiveness in promoting recovery.

While CM did not lead to a significant difference in the number of weeks retained in treatment, participants in the CM condition reported lower rates of substance use at the 9-month follow-up, suggesting potential long-term benefits of this incentive-based approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Low-cost contingency management in community clinics: delivering incentives partially in group therapy. Alessi, SM., Hanson, T., Wieners, M., et al.[2016]

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]

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]

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]

Contingency management procedures have been shown to effectively treat substance use disorders by providing rewards, like vouchers, for drug abstinence, particularly in psychosocial and methadone maintenance settings.

Recent adaptations of these procedures include using lower-cost reinforcers and expanding their application to improve treatment attendance, adherence to goals, and medication compliance, highlighting the versatility of this approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management for treatment of substance abuse. Stitzer, M., Petry, N.[2019]

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]

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]

References

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

Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. [2021]

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

Low-cost contingency management in community clinics: delivering incentives partially in group therapy. [2016]

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

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

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

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

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

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

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

Contingency management for treatment of substance abuse. [2019]

8. 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]

9. Germany pubmed.ncbi.nlm.nih.gov

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