Contingency Management Research Articles

Toward an era of impact of digital contingency management in the treatment of substance use disorders

Digital contingency management entails remote methods to obtain biochemical confirmation of drug status and provide desirable, tangible consequences contingent on abstinence. Advances in digital CM suggest that it may be on the cusp of making a public health impact. Specific advances include technological capabilities and affordability, companies that specialize in digital CM, policies and reimbursement models, and the increasing availability of resources related to CM. Digital CM has expanded from cigarette smoking to alcohol and illicit substance misuse, and to include a diverse range of underserved and high-risk groups (e.g., pregnant and postpartum women, socioeconomically disadvantaged individuals, adolescents, and rural populations). Although the digital divide continues to narrow, culturally responsive methods may increase uptake and engagement with digital CM. The promise of digital CM is widescale access to an evidence-based treatment with low staff burden, no side effects, high fidelity engagement, acceptability, and effectiveness, and greater equity. We may be close to realizing this promise.

Cognitive behavioral therapy treatment for drug addiction

Drug addiction remains a major health concern following its devastating consequences to the users and the economy. Current statistics show a rising trend in substance abuse around the globe with approximately 284 million people engaging in drug abuse. Various approaches are used to treat the victims of drug abuse. Cognitive behavior therapy, a form of nonpharmacological intervention, has also been shown to be an effective treatment option for drug addiction. The use of Cognitive Behavioral Therapy (CBT) has grown since the 1970s to become one of the most important models of psychotherapy in this decade. Various empirical studies have shown the efficacy of CBT in well-controlled trials. A total of 19 randomized trials (cases) (with over 1400 patients treated) were selected and studied. In the various cases, results showed that patients were treated for drug and substance abuse disorders with the majority being those who abused cannabis, cocaine, alcohol and other opioids. In most cases, the CBT techniques that were used for drug addiction included cognitive restructuring, relapse prevention and contingency management. Components of CBT for drug addiction include skills and training, amplification of non-substance-related activities, approaches for managing urges, drug rejection and improvement of social aptitudes. Cognitive restructuring focuses on the identification of misconceptions and influencing the way people think about themselves by eliminating distorted thinking. Relapse prevention focuses on the identification and prevention of high-risk situations that may trigger the patient to engage in drug abuse. Contingency management reinforces positive behaviors and reduces negative behaviors through the use of rewards and incentives.

Expanding access to treatment for stimulant use disorder in a frontier state: A qualitative study of contingency management and TRUST program implementation in Montana

BackgroundThe client population eligible for treatment services supported by State Opioid Response (SOR) grant funding, administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), was expanded to include individuals with a stimulant use disorder (stimUD) in 2020. Due to a significant need to improve services for individuals with stimUD in Montana, the Behavioral Health and Developmental Disabilities Division (BHDD) of the Montana Department of Public Health and Human Services used the grant opportunity to work with experts in the field of stimUD to pilot contingency management (CM) and the Treatment for Individuals who Use Stimulants (TRUST) treatment model. The CM protocol included twice weekly visits for twelve weeks, using an escalating schedule of gift card incentives contingent upon stimulant-negative urine samples. TRUST is a multi-component treatment program, incorporating exercise, group therapy, and individual therapy with content guided by cognitive behavioral therapy (CBT) and clinical research associate (CRA) materials. In addition to SOR dollars, BHDD used additional funding for CM reinforcers provided by state tax dollars to meet research-supported target incentive totals. MethodsIn this pilot project, TRUST/CM was implemented by four state-approved treatment providers and three Federally Qualified Health Centers (FQHCs), all of which had little prior experience with CM as a component of their treatment programs for stimUD. This article examines the processes of training staff, the experiences among staff with initial implementation of the treatment model, and the client characteristics of initial pilot treatment cohorts. Data for this study include primary qualitative data collected from providers, as well as client characteristics collected on the SAMHSA Government Performance and Results Act (GPRA) data collection form. ResultsSeven sites were trained in TRUST/CM, and these sites enrolled a total of 70 patients in the program. Qualitative data collected through interviews with site staff revealed the following themes: the value of intensive technical assistance being integrated in the program, concerns about staff retention and loss of expertise, adjustments of target client populations, and the importance of creative strategies for the provision of evidence-informed incentive totals. ConclusionsTRUST/CM was implemented throughout Montana, including rural and urban communities. Qualitative and quantitative data support that providers viewed the CM component as beneficial for treatment retention and improved outcomes for people with stimUD. These implementation study results provide insight into challenges and solutions for providers who are considering the implementation of CM within either a state-approved substance use treatment clinic or FQHC.

Components of Behavioral Parent Training for Children With Attention-Deficit/Hyperactivity Disorder: A Series of Replicated Single-Case Experiments.

Behavioral parent training (BPT) is an evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD). Stimulus control techniques (antecedent-based techniques, e.g., clear rules, instructions) and contingency management techniques (consequent-based techniques, e.g., praise, ignore) are the most common ones that are being taught to parents in BPT. However, research into the additive effects of these techniques is scarce. In this replicated single-case experimental ABC phase design, including six children on stable medication for ADHD (8-11 years) and their parents, the added efficacy of consequent-based techniques on top of antecedent-based techniques was evaluated. After a baseline period (phase A), we randomized the commencement time of two sessions parent training in antecedent-based techniques and two sessions parent training in consequent-based techniques for each child. Children's behaviors were assessed by daily parent ratings of selected problem behaviors and an overall behavior rating. Although visual inspection showed that behavior improved for most children in both phases, randomization tests did not demonstrate the added efficacy of the consequent-based techniques on top of the antecedent-based techniques. Limitations of the study and recommendations for future single-case experiments in this population are discussed.

Development of Mobile Contingency Management for Cannabis Use Reduction

Many interventions for cannabis use disorder (CUD) are associated with decreases in frequency and quantity of use but fail to increase overall rates of sustained abstinence. It is currently unknown whether reductions in use (in the absence of sustained abstinence) result in clinically significant improvements in functioning. The objective of this study was to refine a mobile contingency management approach to reduce cannabis use to ultimately evaluate whether reductions in frequency and quantity of cannabis are related to improvements in functional and mental health status. Three cohorts of participants (n = 18 total, n = 10 women) were enrolled and completed 2 weeks of ecological momentary assessment (EMA) during a baseline ad lib cannabis use period, followed by a 6-week reduction period. Participants completed EMA assessments multiple times per day and were prompted to provide videotaped saliva cannabis testing 2–3 times daily. Data from participants who were at least 80% adherent to all EMA prompts were analyzed (13 out of 18). During the ad lib phase, participants were using cannabis on 94% of the days and reported using a mean of 1.42 grams daily. The intervention was a mobile application that participants used to record cannabis use by saliva tests to bioverify abstinence and participants completed electronic diaries to report their grams used. During the 6-week intervention phase, participants reported reducing their use days to 47% of the days with a reported mean of .61 grams daily. In the last cohort, at least 50% of the heavy users were able to reduce their cannabis use by at least 50%. The effect of cannabis reduction (versus abstinence) is largely unknown. Observations suggest that it is possible to develop a mobile intervention to reduce cannabis use among heavy users, and this paradigm can be utilized in future work to evaluate whether reductions in cannabis use among heavy users will result in improvements in functional and mental health status.

Implications of epidemic-pandemic convergence for routine care adoption of contingency management: A case study.

The significant increase in opioid-related drug overdoses during the coronavirus disease (COVID-19) pandemic has put an unprecedented burden on hospital emergency departments, who saw as high as an approximate 150% increase in emergency department (ED) admission rates in the initial months of the pandemic. Although overdose is a clear sign of problem drug use, only a small proportion of nonfatal overdose patients enroll in treatment within 30 days of their overdose. To bridge the gap between opioid overdoses and treatment entry, a smartphone-smart debit card contingency management program was developed to promote entry into medication-assisted treatment by out-of-treatment opioid users who have recently received care in a hospital emergency department. The case study described in this article highlights a successful implementation of this intervention despite numerous disruptions related to COVID-19 that would have made engagement difficult without the remote access to contingency management provided by this technology. Patient status over time is presented in conjunction with contingency management earnings. Technology-based contingency management may provide improved scalability, rigorous outcomes metrics, and lower costs than prior onsite, manual contingency management (CM) approaches. The COVID-19 pandemic, in combination with the opioid epidemic has created a context in which historical obstacles to the adoption of contingency management may be overcome. This case study demonstrates the potential utility of smartphone-based contingency management when in-person care is difficult to access or disrupted. The requirement for further research demonstrating the efficacy of these approaches is discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Ranking Psychological Theories with the Accounting-based Approach to Contingency Management using AHP Technique

Ranking Psychological Theories with the Accounting-based Approach to Contingency Management using AHP Technique

Adapting medical education to the COVID-19 pandemic: the experience of 1520 students

Due to the measures imposed by the argentine government during the SARS-CoV-2 pandemic, the capacity of universities and hospitals for the development of face-to-face educational activities has been restricted. Therefore, we set out to explore the perceptions of the educational impact and the experience in the virtual environment of Argentine medical students. We carried out an observational, analytical, cross-sectional study. The data collection was carried out through a national questionnaire in the period between April 19 and June 15, 2020 through a “snowball” type sampling. The study population involved medical students from Argentina (n = 1520 students). From which we observed that 95.41% (n = 1505) believed that their formation was affected, only 56.14% (n = 850) of the universities were able to virtualize all the subjects, and 97.69% (n = 1479) believed that argentine universities were not fully prepared. As for their experience in virtuality; 92.98% (n = 1364) reported that virtual education allowed them to advance in their career, 76.89% (n = 1128) indicated that the quality of the virtual classes got worse compared to the face-to-face ones, and 58.55% (n = 859) did not have the possibility to take an exam virtually. Consequently, we concluded that the COVID-19 pandemic exposed the need to prepare medical careers for the management of educational contingencies. The results of this research reflect a student population affected in their learning by this situation. Educational policies that take into account the needs expressed by students are crucial.

Use of a sequential multiple assignment randomized trial to test contingency management and an integrated behavioral economic and mindfulness intervention for buprenorphine-naloxone medication adherence for opioid use disorder

BackgroundBuprenorphine-naloxone is a medication shown to improve outcomes for individuals seeking treatment for opioid use disorder (OUD); however, outcomes are limited by low medication adherence rates. This is especially true during the early stages of treatment.MethodsThe present study proposes to utilize a sequential multiple assignment randomized trial design to compare two psychological interventions targeting buprenorphine-naloxone adherence: (1) contingency management (CM) and (2) brief motivational interviewing plus substance-free activities session plus mindfulness (BSM). Participants will be N = 280 adults who present to a university-based addictions clinic seeking treatment for OUD. Participants will be randomized to condition to receive 4 sessions of their assigned intervention (CM or BSM). Participants who are adherent, defined as attending physician appointments and having buprenorphine present in urine toxicology, will enter maintenance intervention for an additional 6 months. Those who are not adherent will be re-randomized to receive either the other intervention or both interventions. Follow-up will occur at 8 months post-randomization.ConclusionsThis novel design will examine the benefit of sequential treatment decisions following non-adherence. The primary outcome of this study is buprenorphine-naloxone medication adherence, as assessed by physician visit attendance and presence of buprenorphine in urine. Results will elicit the relative efficacy of CM and BSM compared to one another and whether keeping the initial treatment approach when adding the alternative approach for initially non-adherent individuals is beneficial.Trial registrationClinicalTrials.gov NCT04080180

Role of Dual-Contingency Management in Family-Based Obesity Therapy and the Effects of Weight Loss on Liver Transient Elastography Parameters in Youth: A Pilot Study.

The pilot study evaluated contingency management (CM) for family-based obesity therapy (FBT). The secondary outcome assessed the association of the hepatic transient electrography (TE) parameters, including the controlled attenuation parameter (CAP) and liver stiffness (LSM), and changes in liver function blood tests and BMI changes in youth involved in intensive FBT. It included youth-parent dyads from an urban pediatric center randomized to weekly behavioral therapy (BT, n= 4) who received fixed financial compensation for attendance, or BT+CM (n= 5) who received an escalating monetary reward for weight loss. At week 30, all youth and parents had weight-loss trends without significant differences between groups. While the TE measures and blood tests were normal in the youth at baseline and week 30, the CAP changes correlated with BMI changes (R2= 0.86, P< 0.001) and LSM changes with alanine aminotransferase changes (R2= 0.79, P=0.005). In conclusion, BT+CM did not significantly add to the BMI improvement seen with BT alone in youth and their parents. However, in youth with obesity and normal liver blood tests, TE may be useful for monitoring changes in fatty liver disease.

Organizational and individual contingency factors and management practices

It has been argued that the decision-making process has never been more important (or complex) as it has increased the amount of unstructured information, increasingly hostile competition and frequent innovations. In this context, the Global Management Accounting Principles (GMAP) were proposed with the objective of assisting managers of different organizations to evaluate and improve their Management Accounting System (MAS), improving the information provided and, consequently, decision making. In this way, the aim of this study consisted of analyzing the associations between organizational and individual Contingency factors and management practices from the perspective of the GMAP of the industries in Paraíba. To this end, managers’ data from 86 industries were acquired through the application of an electronic questionnaire during the year 2020. The data analysis was performed using Spearman's correlation. Regarding organizational contingencies, positive and significant associations were found between strategy and practices related to GMAP. However, the size didn’t show significant association with the adoption of such practices. Regarding individual contingencies, negative and significant associations were found between the manager’s time in the position and one of the management practices. Additionally, the manager’s education showed positive and significant association with some practices related to GMAP. In conclusion, no significant associations between manager’s age and management practices were found. This study contributes to the literature by analyzing the antecedents of contemporary management practices from a new perspective (the GMAP). Little is known about the factors that contribute to an effective management accounting function in light of the guidelines provided by the GMAP structure. Likewise, these results may be of interest to professionals as they provide important reflections on the contribution of GMAP to management, as well as they point to the need for such practices to be implemented considering the specific context of each organization.

Stimulant use among patients in opioid treatment settings: Provider perspectives

IntroductionMethadone maintenance therapy (MMT) has been a pillar of opioid addiction treatment. Opioid treatment programs (OTPs) have been faced with an escalating threat of stimulant use and related overdose deaths among patients. We know little about how providers currently address stimulant use while maintaining treatment for opioid use disorder. MethodsWe conducted 5 focus groups with 36 providers (n = 11 prescribers; 25 behavioral health staff), and collected an additional 46 surveys (n = 7 prescribers; 12 administrators; 27 behavioral health staff). Questions focused on perceptions of patient stimulant use and interventions. We applied inductive analysis to identify themes relevant to identification of stimulant use, use trends, intervention approaches, and perceived needs to improve care. ResultsProviders indicated a trend of rising stimulant use among patients, especially those experiencing homelessness or comorbid health conditions. They reported a range of approaches to patient screening and intervention, including medication and harm reduction, improving treatment engagement, increasing level of care, and providing incentives. Providers expressed less agreement as to which of these interventions were effective, and though providers saw stimulant use as a common and severe problem, they reported little problem recognition and interest in treatment from their patients. A particular concern of providers was the prevalence and danger of synthetic opioids, such as fentanyl. They sought more research and resources to identify effective interventions and medications to address these issues. Also notable was an interest in contingency management (CM) and use of reinforcements/rewards to encourage stimulant use reduction. ConclusionProviders face challenges in treating patients who use both opioids and stimulants. Although methadone is available to treat opioid use, no such “silver bullet” exists for stimulant use disorder. The rise in stimulant and synthetic opioid (e.g., fentanyl) combination products is presenting an extraordinary challenge for providers whose patients are at unprecedented risk for overdose. Providing OTPs with more resources to address polysubstance use is critical. Existing research indicates strong support for CM in OTPs, but providers reported regulatory and financial barriers to implementation. Further research should develop effective interventions that are accessible to providers in OTPs.

Exploring psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder.

Methamphetamine use disorder is a chronic relapsing condition associated with substantial mental, physical, and social harms and increasing rates of mortality. Contingency management and psychotherapy interventions are the mainstays of treatment but are modestly effective with high relapse rates, while pharmacological treatments have shown little to no efficacy. Psilocybin-assisted psychotherapy is emerging as a promising treatment for a range of difficult-to-treat conditions, including substance use disorders; however, no studies have yet been published looking at psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder. Here we review the rationale for psilocybin-assisted psychotherapy as a potential treatment for this indication, and describe practical considerations based on our early experience designing and implementing four separate clinical trials of psilocybin-assisted psychotherapy for methamphetamine use disorder.

Contingency management, best treatment for stimulants, essential with fentanyl

Instead of going to various lengths to persuade or cajole or encourage patients addicted to stimulants to stop, the best method is still contingency management (CM), experts agree. In this modality, patients are paid to stop using, but the problem is that the payments are far too low and under federal anti‐kickback rules, the government still refuses to allow them to be higher. Richard A. Rawson, Ph.D., research professor at the Vermont Center on Behavior and Health at the University of Vermont, is the original developer, going back three decades, of this treatment. Now, with so many people thinking they are getting stimulants on the street, but instead consuming illicit fentanyl, Rawson says it's urgent that CM be used.

Environmental risk assessment of petrogenic hydrocarbon spills in mangrove ecosystems: the Tumaco case study as a baseline, Colombian Pacific.

Petrogenic hydrocarbon spills (PHS) are harmful to mangrove ecosystems along tropical coastlines in the short and long term. The aim of this study was to assess the environmental risk of recurrent PHS on mangrove ecosystems in Tumaco municipality, Colombian Pacific. Mangrove characteristics and management aspects led to subdividing the study area into 11 units-of-analysis (UAs) for which threats, vulnerability, potential impacts, and risks were assessed based on environmental factors and the formulation and use of indicators in a rating scale with five categories, which are very low, low, moderate, high, and very high. The results showed that all UAs are highly (64%; 15,525ha) or moderately (36%; 4,464ha) threatened by PHS, highly (45%; 13,478ha) or moderately (55%; 6,511ha) vulnerable to this kind of pollution, and susceptible to high (73%; 17,075ha) or moderate (27%; 2,914ha) potential impacts. The environmental risk was high in 73% (17,075ha) of the UAs, indicating likely irreversible damage to mangrove ecosystems by PHS, thus pointing to the need of urgent intervention by responsible authorities to ease their recovery and conservation. The methodology and results of this study become technical inputs that serve for environmental control and monitoring, which can be incorporated into contingency and risk management plans.

Digital Contingency Management in the Treatment of Substance Use Disorders

Contingency management (CM) provides incentives based on drug abstinence or other treatment goals; it is one of the most efficacious and cost-effective psychosocial interventions for substance use disorders. However, CM remains severely underused in clinical care. Digital methods to deliver CM could dramatically expand access. These methods include information and drug sensing technologies to obtain objective evidence of drug abstinence, authenticate the end-user's identity, and deliver incentives immediately. Digital CM has been applied successfully to cigarette smoking, alcohol misuse, and more recently illicit drug use. Policies should continue to evolve to promote the delivery of digital CM based on decades of research.

Prescription psychostimulants for cocaine use disorder: A review from molecular basis to clinical approach.

Cocaine use is a public health concern in many countries worldwide, particularly in the Americas and Oceania. Overdose deaths involving stimulants, such as cocaine, have been increasing markedly in North America, especially with concurrent opioid involvement. To date, no pharmacological treatment is available to treat stimulant (including cocaine) use disorders. Prescription psychostimulants (PPs) could be useful to treat cocaine use disorder (CUD) as they share the pharmacological effects with cocaine, as evidenced by a recent meta-analysis that assessed 38 randomized clinical trials (RCTs). PPs were found to promote sustained abstinence and reduce drug use in patients with CUD. The aim of this paper is to provide a narrative review of the clinical pharmacology of PPs and comment on the current stage of evidence supporting PPs to treat CUD. We also propose a model of care that integrates PPs with evidence-based psychosocial interventions (such as cognitive-behavioural therapy [CBT] and contingency management [CM]), a harm reduction approach and case management with social support.

Operational Reliability Evaluation of Urban Multi-Energy Systems With Equivalent Energy Storage

With the coordination of multiple energies at the city level, the complexity of the urban energy system is ever-increasing. Securing the reliable operation of the urban multi-energy system (UMES) has become a challenging task. This article focuses on the operational reliability evaluation of the UMES considering the incorporation of equivalent energy storages. First, a novel concept of dynamic energy hub is proposed, as a unified tool to characterize the dynamic relationships of the operating conditions of diverse components in the UMES. Then, the temperature-controlled load (TCL) is modeled as the equivalent energy storage considering the thermal dynamics. Its operational reliabilities, as well as multiple other components, are modeled using the reliability equivalent technique to reduce the dimension of uncertainties. Moreover, a contingency management scheme of the UMES is developed in an optimal control framework considering the comfort costs of equivalent energy storages. To deal with the time-dependency of the optimal control problem, a simplified Benders decomposition procedure is devised and embedded in the Time-sequential Monte Carlo simulation to improve the computation efficiency of the reliability evaluation. Finally, a practical case of a UMES in southern China is used to validate the proposed technique.

Managerial Skills and Organizational Performance among School Heads: A Contingency Management Action Plan

Managerial Skills and Organizational Performance among School Heads: A Contingency Management Action Plan

Transcranial Stimulation for the Treatment of Stimulant Use Disorder

The increasing prevalence of stimulant use disorder (StUD) involving methamphetamine and cocaine has been a growing healthcare concern in the United States. Cocaine usage is associated with atherosclerosis, systolic and diastolic dysfunction, and arrhythmias. Furthermore, approximately one of every four MIs is cocaine-induced among patients aged 18 to 45. Methamphetamine use has been associated with nerve terminal damage in the dopaminergic system resulting in impaired motor function, cognitive decline, and co-morbid psychiatric disorders. Current treatment options for StUD are extremely limited, and there are currently no FDA-approved pharmacotherapies. Behavioral interventions are considered first-line treatment; however, in a recent meta-analysis comparing behavioral treatment options for cocaine, contingency management programs provided the only significant reduction in use. Current evidence points to the potential of various neuromodulation techniques as the next best modality in treating StUD. The most promising evidence thus far has been transcranial magnetic stimulation which several studies have shown to reduce risk factors associated with relapse. Another more invasive neuromodulation technique being studied is deep-brain stimulation, which has shown promising results in its ability to modulate reward circuits to treat addiction. Results showing the impact of transcranial magnetic stimulation (TMS) in the treatment of StUD are limited by the lack of studies conducted and the limited understanding of the neurological involvement driving addiction-based diseases such as StUD. Future studies should seek to provide data on consumption-reducing effects rather than craving evaluations.