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

Trial Summary

What is the purpose of this trial?

The overarching purpose of this pilot study is to investigate an increasingly common, but under-researched, practice of employing paraprofessional coaches to improve emerging adults' access to and engagement in evidence-based substance use practices, focusing on the paraprofessional coaches' outcomes and the role of lived experience.

Will I have to stop taking my current medications?

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

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

Research shows that Contingency Management (CM), which uses rewards like vouchers or prizes, helps people stay in treatment longer and achieve longer periods of abstinence from substances like cocaine and heroin. These longer periods of abstinence during treatment are linked to better outcomes after treatment ends. ^{1 2 3 4 5}

Is Contingency Management safe for humans?

Research on Contingency Management (CM) for substance use disorders, including methods like vouchers and prizes, shows it is generally safe for humans. Studies have not reported significant safety concerns, and CM has been effective in promoting abstinence without increasing substance use. ^{1 2 4 6 7}

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

Contingency Management (CM) is unique because it uses incentives like vouchers or prizes to encourage abstinence from substance use, which can be combined with vocational or educational coaching to enhance outcomes. This approach focuses on rewarding positive behavior changes, making it different from traditional treatments that may not use such direct reinforcement strategies. ^{1 2 4 8 9}

Eligibility Criteria

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

I am between 18 and 26 years old.

I am between 18 and 30 years old.

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

Exclusion Criteria

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

Emerging Adult Clients: Currently unhoused without a primary address

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

Timeline

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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 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]

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]

References

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

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

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

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

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

Give them prizes, and they will come: contingency management for treatment of alcohol dependence. [2022]

4. 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]

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

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

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

Contingency management in cocaine abusers: a dose-effect comparison of goods-based versus cash-based incentives. [2022]

7. Germany pubmed.ncbi.nlm.nih.gov

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

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

Contingency management for treatment of substance abuse. [2019]

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

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