Combatting the rise of the opioid epidemic is a central challenge of U.S. health care policy. A promising approach for improving welfare and decreasing medical costs of people with substance abuse disorders is offering incentive payments for healthy behaviors. This approach, broadly known as "contingency management" in the medical literature, has repeatedly shown to be effective in treating substance abuse. However, the use of incentives by treatment facilities remains extremely low. Furthermore, it is not well understood how to design optimal incentives to treat opioid abuse. This project will conduct a randomized evaluation of two types of dynamically adjusting incentive schedules for people with opioid use disorders or cocaine use disorders: "escalating" schedules where incentive amounts increase with success to increase incentive power, and "de-escalating" schedules where incentive amounts decrease with success to improve incentive targeting. Both schemes are implemented with a novel "turnkey" mobile application, making them uniquely low-cost, low-hassle, and scalable. Effects will be measured on abstinence outcomes, including longest duration of abstinence and the percentage of negative drug tests. In combination with survey data, variation from the experiment will shed light on the barriers to abstinence more broadly and inform the understanding of optimal incentive design.
Age at least 18 years old;
Meet DSM-5 OUD, CoUD, or MUD criteria as evidenced by an OUD CPT code F11* (opioid related disorders), a CoUD CPT code F14* (cocaine related disorders), a MUD CPT code F15.1/F15.2 or other clinical notes indicating illicit opioid/cocaine/methamphetamine use for treatment
Have access to a smartphone (iOS or Android) with data plan and willing to download DynamiCare app;
Have an email and can access it from their smartphone;
Have evidence of active (non-substance related) psychosis that might impair participation as determined by the PI.
Has significant cognitive impairment that might confound participation as determined by the PI or are so significantly cognitively impaired that they have a legal guardian.
Parallel
App-Based Contingency Management
BehavioralParticipants will receive financial incentives for submitting randomly generated drug-negative saliva tests across the intervention period.
Sham Control
BehavioralParticipants get access to the DynamiCare app but will not be provided with financial incentives.
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Treatment groupsSee each treatment group below.
Percent of Negative Saliva Tests
Percent of tests negative for non-medical opioids, cocaine, or stimulant
Percent of App Acceptability
Percent of eligible population which accepts app
Percent of Psychotherapy Visits Attended
Percent of Treatment Discharge Against Medical Advice
Percent of patients of discharging from treatment before completion
Percent of Relapse
Percent of patients who step up in care to inpatient, residential, or day partial hospitalization treatment program (PHP)
Percent of transition to step-down care
Percent of patients who transition to appropriate step-down care within 14 days of enrollment in treatment
Click on the lead sponsor to view all of their trials.
Wake Forest University Health Sciences
Lead sponsor
University of Chicago
Collaborator
Rogers Behavioral Health
Collaborator
University of California Santa Cruz
Collaborator
