Contingency Management + Coaching for Substance Use Disorders

(PEERS Trial)

Recruiting at 1 trial location

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Chestnut Health Systems

Disqualifiers: Federal disability, Unhoused, Life threatening condition

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

Compensation: Varies

Number of Visits: Unknown

Duration: 6 months

80 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how paraprofessional coaches can help young adults access and engage in evidence-based treatments for substance use disorders. It compares the effectiveness of contingency management (a system of rewards) combined with coaching from two types of coaches: those with lived experience and those without. The study seeks participants who are young adults, have had interactions with the legal system, and screen positive for substance use disorder. As an unphased trial, it offers participants the chance to contribute to innovative research that could enhance treatment access and engagement for young adults facing similar challenges.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that Contingency Management (CM) is a well-researched, safe, and effective treatment for substance use disorders. CM uses rewards like vouchers or prizes to motivate individuals to avoid substance use. For over 30 years, studies have demonstrated that CM helps people stop using various substances, including stimulants and opioids.

Combining CM with job or education coaching is a newer approach, but both components are generally safe. The coaching assists individuals with their job or school goals, providing extra support without medical risks. This method emphasizes positive reinforcement, offering a safe and supportive way to help people make lasting changes. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it's exploring how contingency management (CM) combined with vocational/educational coaching can help people with substance use disorders in new ways. Unlike traditional treatments that primarily focus on therapy or medication, this approach integrates motivational incentives with skill-building, offering a more holistic recovery path. What sets it apart is the personalized coaching aspect from individuals with and without lived experience, which could provide unique, relatable support or diverse perspectives, potentially enhancing success rates. This trial could illuminate how tailored support models might better meet the diverse needs of individuals seeking recovery.

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

Research has shown that contingency management (CM) effectively treats substance use disorders. With over 30 years of evidence, CM helps individuals remain in treatment longer and increases the likelihood of staying drug-free, particularly from drugs like cocaine. In this trial, participants will receive CM combined with vocational and educational coaching. Studies have found that integrating CM with additional support, such as coaching, enhances its effectiveness. Job or education coaching can further assist individuals by focusing on personal growth and life skills. Overall, CM has a strong track record of helping people reduce drug use and stay committed to their treatment. ^{1 3 4 5 6}

Are You a Good Fit for This Trial?

This trial is for two groups: paraprofessional coaches aged 18-30 without life-threatening conditions, and emerging adult clients aged 18-26 on parole or probation with substance use disorders. Clients must have a stable address and not qualify for federal disability that would interfere with coaching.

Inclusion Criteria

Emerging Adult Clients: Have at least 6 months remaining on their parole and probation sentence

Emerging Adult Clients: Screen positive for substance use disorder

Exclusion Criteria

Emerging Adult Clients: Currently unhoused without a primary address

Emerging Adult Clients: Life threatening or unstable condition requiring treatment (e.g., suicidal/homicidal ideation)

I receive federal disability benefits that prevent me from participating in educational or vocational coaching.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive contingency management combined with vocational/educational coaching from paraprofessional coaches with or without lived experience

6 months

Monthly sessions

Follow-up

Participants are monitored for changes in substance use, vocational/educational attainment, and criminal legal system involvement

24 months

Biannual assessments

Long-term Monitoring

Continued assessment of paraprofessional coach outcomes and client engagement

30 months

What Are the Treatments Tested in This Trial?

Interventions

• Contingency Management (CM)
• Contingency Management (CM) combined with vocational/educational coaching

Trial Overview The study tests Contingency Management (CM) combined with vocational/educational coaching to reduce drug use in young adults involved in the justice system. It focuses on how well non-professional coaches can help these individuals engage in treatment.

How Is the Trial Designed?

Group I: CM combined with Vocational/educational Coaching from Coaches without Lived Experience Experimental Treatment 1 Intervention

This group will receive contingency management (CM) combined with vocational/educational coaching from paraprofessional coaches without lived experience in community settings.

Group II: CM combined with Vocational/educational Coaching from Coaches with Lived Experience Active Control 1 Intervention

This group will receive contingency management (CM) combined with vocational/educational coaching from paraprofessional coaches with lived experience in community settings.

Who Is Running the Clinical Trial?

Chestnut Health Systems

Lead Sponsor

Trials

27

Recruited

24,500+

Oregon Social Learning Center

Lead Sponsor

Trials

36

Recruited

8,900+

National Institute on Drug Abuse (NIDA)

Collaborator

Trials

2,658

Recruited

3,409,000+

Published Research Related to This Trial

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 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]

In a study of 42 alcohol-dependent veterans, those who received contingency management (CM) alongside standard treatment had a much higher retention rate in treatment (84%) compared to those receiving only standard treatment (22%).

By the end of the 8-week treatment period, 69% of CM participants remained abstinent from alcohol, while 61% of those in standard treatment had relapsed, indicating that CM is an effective strategy for promoting abstinence in alcohol treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Give them prizes, and they will come: contingency management for treatment of alcohol dependence. Petry, NM., Martin, B., Cooney, JL., et al.[2022]

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]

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]

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]

Contingency management (CM) is an effective treatment for stimulant use disorders, and this guide provides a structured protocol to enhance its implementation in clinical settings.

The article emphasizes the importance of adhering to evidence-based practices in CM, as poorly designed programs are unlikely to improve patient outcomes, highlighting the need for careful planning and preparation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing an evidence-based prize contingency management protocol for stimulant use. Rash, CJ.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6768932/

Voucher-Based Contingency Management is Efficacious ... In this report, we review research demonstrating the efficacy of voucher-based contingency management delivered alone or in combination with other interventions ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5714694/

Contingency management treatment for substance use ... Research on this intervention dates back over 30 years and consistently shows that CM improves drug abuse treatment outcomes (Higgins, Silverman, & Heil, 2008; ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0740547212001535

Contingency management is effective across cocaine ... Contingency management (CM) interventions have been proven to be efficacious for improving retention and abstinence rates in treatment for cocaine dependence ( ...

4. aspe.hhs.gov aspe.hhs.gov/sites/default/files/documents/a0cc6fcdb2968be95f60bb1c2c94eb70/contingency-management-sub-treatment.pdf

Contingency Management for the Treatment of Substance ... CM has three decades of research demonstrating its long-term efficacy for treating a variety of SUDs, including stimulant, opioid, cannabis, ...

5. withpower.com withpower.com/trial/phase-substance-related-disorders-3-2023-3d699

Contingency Management + Coaching for Substance Use ... Trial Overview The study tests Contingency Management (CM) combined with vocational/educational coaching to reduce drug use in young adults involved in the ...

6. library.samhsa.gov library.samhsa.gov/sites/default/files/contingency-management-advisory-pep24-06-001.pdf

contingency-management-advisory-pep24-06-001.pdf Contingency management (CM) is a proven health care intervention with demonstrated effectiveness in treating a variety of substance use disorders (SUDs) ...