Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone-Based Contingency Management Intervention for Buprenorphine Adherence

DeFulio, Anthony; Brown, Hayley D.; Davidson, Rosemarie M.; Regnier, Sean D; Kang, Navdeep; Ehart, Melissa

doi:10.1007/s40617-022-00730-8

Cited by 7 publications

(6 citation statements)

References 35 publications

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“…Incentives are delivered via an anonymous credit card that cannot be used to withdraw cash and has additional purchasing protections. Studies show preliminary effectiveness of this model in patients with OUD, including one with patients who have concurrent StUD 89-91 …”

Section: Behavioral Treatmentmentioning

confidence: 96%

“…Studies show preliminary effectiveness of this model in patients with OUD, including one with patients who have concurrent StUD. [89][90][91] The CGC reviewed available evidence for a number of technology-based and alternative interventions but found it to be insufficient to include in the recommendation statements at this time. These items can be found in Appendix F, http://links.…”

Section: Technology-based Interventionsmentioning

confidence: 99%

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The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder

2024

J Addict Med

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Section: Behavioral Treatmentmentioning

confidence: 96%

Section: Technology-based Interventionsmentioning

confidence: 99%

The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder

2024

J Addict Med

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“…Incentive group participants entered buprenorphine treatment at a much higher rate, but buprenorphine adherence and drug abstinence were similar in the two groups. In contrast, a single-group non-experimental evaluation indicated that a similar intervention was very promising as a means of promoting buprenorphine adherence and retention in treatment (DeFulio et al, 2022). Finally, another technology-based CM feasibility study enrolled methadone patients who received observed dosing at community pharmacies (Metrebian et al, 2021).…”

Section: Technology To Promote Access To High-fidelity CMmentioning

confidence: 99%

Digital Contingency Management in the Treatment of Substance Use Disorders

Dallery

DeFulio

Raiff

2023

Policy Insights from the Behavioral and Brain Sciences

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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.

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“…Participants in this pilot study received access to a brief version of the DynamiCare Health program (Boston, Massachusetts) that was customized for this study. The program is commercially available and has been evaluated as a tool for increasing nicotine cessation in people who smoke or vape nicotine [15][16][17], alcohol abstinence in adults with alcohol use disorder [10], and drug abstinence and treatment adherence in patients with opioid use disorders [11][12][13]. No studies have been published regarding the feasibility of these particular program components when used as a completely remote intervention for methamphetamine use.…”

Section: Overviewmentioning

confidence: 99%

“…For example, digital apps and smartphone cameras could make it easier for patients to submit biological substance self-testing results (eg, patients may video record themselves completing saliva-based substance tests from any location without requiring in-person clinic visits or clinician time to administer the substance tests). Similarly, these technologies can make it easier to disburse financial incentives after recent methamphetamine abstinence has been verified via self-testing (eg, money can be loaded immediately onto reloadable debit cards by staff who can review videos from any location) [10][11][12][13]. Commercially available mHealth programs could also potentially aid the delivery of CM in health care settings where clinical expertise, staffing, and workflow limitations have traditionally hindered the implementation of CM, for example, by delegating the responsibilities for verifying methamphetamine abstinence and disbursing rewards to dedicated CM program staff outside the clinic.…”

Section: Introductionmentioning

confidence: 99%

Feasibility, Engagement, and Usability of a Remote, Smartphone-Based Contingency Management Program as a Treatment Add-On for Patients Who Use Methamphetamine: Single-Arm Pilot Study

Hallgren¹,

Duncan²,

Iles-Shih³

et al. 2023

JMIR Form Res

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Background In the United States, methamphetamine-related overdoses have tripled from 2015 to 2020 and continue to rise. However, efficacious treatments such as contingency management (CM) are often unavailable in health systems. Objective We conducted a single-arm pilot study to evaluate the feasibility, engagement, and usability of a fully remotely delivered mobile health CM program offered to adult outpatients who used methamphetamine and were receiving health care within a large university health system. Methods Participants were referred by primary care or behavioral health clinicians between September 2021 and July 2022. Eligibility criteria screening was conducted by telephone and included self-reported methamphetamine use on ≥5 out of the past 30 days and a goal of reducing or abstaining from methamphetamine use. Eligible participants who agreed to take part then completed an initial welcome phase that included 2 videoconference calls to register for and learn about the CM program and 2 “practice” saliva-based substance tests prompted by a smartphone app. Participants who completed these welcome phase activities could then receive the remotely delivered CM intervention for 12 consecutive weeks. The intervention included approximately 24 randomly scheduled smartphone alerts requesting a video recording of themselves taking a saliva-based substance test to verify recent methamphetamine abstinence, 12 weekly calls with a CM guide, 35 self-paced cognitive behavioral therapy modules, and multiple surveys. Financial incentives were disbursed via reloadable debit cards. An intervention usability questionnaire was completed at the midpoint. Results Overall, 37 patients completed telephone screenings, with 28 (76%) meeting the eligibility criteria and consenting to participate. Most participants who completed a baseline questionnaire (21/24, 88%) self-reported symptoms consistent with severe methamphetamine use disorder, and most had other co-occurring non-methamphetamine substance use disorders (22/28, 79%) and co-occurring mental health disorders (25/28, 89%) according to existing electronic health records. Overall, 54% (15/28) of participants successfully completed the welcome phase and were able to receive the CM intervention. Among these participants, engagement with substance testing, calls with CM guides, and cognitive behavioral therapy modules varied. Rates of verified methamphetamine abstinence in substance testing were generally low but varied considerably across participants. Participants reported positive opinions about the intervention’s ease of use and satisfaction with the intervention. Conclusions Fully remote CM can be feasibly delivered within health care settings lacking existing CM programs. Although remote delivery may help reduce barriers to treatment access, many patients who use methamphetamine may struggle to engage with initial onboarding. High rates of co-occurring psychiatric conditions in the patient population may also contribute to uptake and engagement challenges. Future efforts could leverage greater human-to-human connection, more streamlined onboarding procedures, larger incentives, longer durations, and the incentivization of non–abstinence-based recovery goals to increase uptake and engagement with fully remote mobile health–based CM.

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Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone-Based Contingency Management Intervention for Buprenorphine Adherence

Cited by 7 publications

References 35 publications

The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder

The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder

Digital Contingency Management in the Treatment of Substance Use Disorders

Feasibility, Engagement, and Usability of a Remote, Smartphone-Based Contingency Management Program as a Treatment Add-On for Patients Who Use Methamphetamine: Single-Arm Pilot Study

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