Implementing Contingency Management for Stimulant Use in Specialty Addiction Treatment Organizations

NCT ID: NCT05702021

Last Updated: 2025-04-01

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 76 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-06-07
• Study Completion Date: 2027-08-01

Brief Summary

Stimulants constitute a new and deadly fourth wave of the opioid epidemic. Contingency management is the most effective intervention for stimulant use and is an evidence-based adjunct to medication for opioid use disorder. Yet, uptake of contingency management in opioid treatment programs that provide medication for opioid use disorder remains low; in fact, access to contingency management is arguably one of the greatest research-to-practice gaps in the addiction treatment services field. The goal of this study is to conduct a type III hybrid effectiveness-implementation trial to evaluate a multi-level implementation strategy, the Science of Service Laboratory, to install contingency management for stimulant use in opioid treatment programs. The Science of Service Laboratory has three core components: didactic training, performance feedback, and external facilitation.

Utilizing a stepped wedge design, a regional cohort of 10 public sector opioid treatment programs will be randomized to receive Science of Service Laboratory at five distinct time points. At six intervals, each of the 10 opioid treatment programs will provide de-identified electronic medical record data from all available patient charts on contingency management delivery and patient outcomes. Staff from each opioid treatment program will provide feedback on contextual determinants influencing implementation. This study will rigorously evaluate whether a multi-level implementation strategy developed by one of the longest-standing national intermediary purveyor organizations-the SAMHSA Technology Transfer Centers, will improve both implementation and patient outcomes.

Detailed Description

Stimulant use among persons with opioid use disorder is associated with an array of serious consequences. Among those with opioid use disorder, stimulant use has been associated with more persistent opioid use; higher risk of HIV infection; higher levels of family, medical, legal, and vocational problems; and increased risk of fatal overdose. Contingency management is an evidence-based intervention for stimulant use and an evidence-based adjunct to medication for opioid use disorders. Medication for opioid use disorder is the first-line, evidence-based treatment for opioid use disorder, but does not specifically reduce stimulant use, and there are not yet efficacious medications for stimulant addiction. Moreover, individuals who continue to use stimulants while receiving medication for opioid use disorder have worse treatment response in terms of both retention and abstinence from opioids. Contingency management targets stimulant use via reinforcing incentives for attaining abstinence. Despite an abundance of research evidence, contingency management uptake in opioid treatment programs remains low due to barriers at both the provider- and organizational-levels. Effectively addressing the contingency management evidence-to-practice gap could advance both the field of implementation science and the quality of care in specialty addiction treatment settings. This project evaluates a multi-level implementation strategy, the Science to Service Laboratory, to install contingency management for stimulant use in opioid treatment programs. The Science of Service Laboratory employs three core components: didactic training; performance feedback; and external facilitation.

Utilizing a fully powered type III hybrid effectiveness-implementation trial with a stepped wedge design, we will randomize a cohort of 10 public sector opioid treatment programs in New England to receive the Science of Service Laboratory at five time points. Data collection will leverage multiple sources. At six intervals, each of the 10 opioid treatment programs will extract de-identified electronic medical record data on contingency management implementation and patient outcomes. In addition, opioid treatment program staff will report on contextual determinants of implementation. Results will evaluate whether a multi-level implementation strategy initially developed by one of the longest-standing intermediary purveyor organizations (SAMHSA Technology Transfer Centers), will improve implementation and patient outcomes. In addition, the project will ensure equitable service provision to diverse, high-risk patients while advancing implementation science via specification and evaluation of contextual determinants.

The Specific Aims and corresponding hypotheses are:

Specific Aim 1: To test the effectiveness of the Science of Service Laboratory on implementation outcomes, including contingency management Reach, Adoption, and Implementation.

Specific Aim 2: To test the effectiveness of the Science of Service Laboratory on patient outcomes, including: Stimulant Abstinence and Treatment Retention.

Conditions

Stimulant Use (Diagnosis)

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: SINGLE

Study Groups

Science of Service Laboratory implementation strategy

The Science of Service Laboratory implementation strategy consists of: didactic training (contingency management workshops; monthly contingency management coaching calls), performance feedback (practice sessions and electronic medical record feedback); and facilitation (monthly facilitation calls).

Group Type: EXPERIMENTAL

Science to Service Laboratory

Intervention Type: BEHAVIORAL

The Science of Service Laboratory implementation strategy consists of: didactic training (contingency management workshops; monthly contingency management coaching calls), performance feedback (practice sessions and electronic medical record feedback); and facilitation (monthly facilitation calls).

Stepped wedge comparator

Our hybrid trial uses a unidirectional crossover stepped wedge design. All sites cross over in the same direction from usual care to intervention. All sites therefore act as their own comparison prior to the sequential roll-out of the implementation strategy.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Science to Service Laboratory

The Science of Service Laboratory implementation strategy consists of: didactic training (contingency management workshops; monthly contingency management coaching calls), performance feedback (practice sessions and electronic medical record feedback); and facilitation (monthly facilitation calls).

Intervention Type: BEHAVIORAL

Eligibility Criteria

Exclusion Criteria

• Persons on Medication for Opioid Use Disorder [Not recruited, via electronic medical records only]

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role: collaborator

Stanford University

OTHER

Sponsor Role: collaborator

Ohio State University

OTHER

Sponsor Role: collaborator

Northwestern University

OTHER

Sponsor Role: lead

Responsible Party

Sara Becker

Alice Hamilton Professor of Psychiatry

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Sara Becker

Role: PRINCIPAL_INVESTIGATOR

Northwestern University

Locations

Lawndale Christian Health Center

Chicago, Illinois, United States

Site Status: RECRUITING

Healthcare Alternative Systems NEXA-MAR

Chicago, Illinois, United States

Site Status: RECRUITING

Community Outreach Intervention Projects Southside Mobile Van

Chicago, Illinois, United States

Site Status: RECRUITING

Family Guidance Centers Chicago Ave.

Chicago, Illinois, United States

Site Status: RECRUITING

Addiction Recovery Institute

Pawtucket, Rhode Island, United States

Site Status: COMPLETED

CODAC Pawtucket

Pawtucket, Rhode Island, United States

Site Status: COMPLETED

Providence Comprehensive Treatment Center

Providence, Rhode Island, United States

Site Status: COMPLETED

VICTA

Providence, Rhode Island, United States

Site Status: COMPLETED

CODAC Providence

Providence, Rhode Island, United States

Site Status: COMPLETED

Woonsocket Comprehensive Treatment Center

Woonsocket, Rhode Island, United States

Site Status: COMPLETED

Countries

United States

Central Contacts

Medical Director of Behavioral Health Chicago Department of Pu

Role: CONTACT

miao.hua@cityofchicago.org

312-742-0381

Facility Contacts

Brittany Buckner

Role: primary

brittanybuckner@lawndale.org

Marian Jurewicz

Role: primary

MJurewicz@hascares.org

Albert Murphy

Role: primary

amurph20@uic.edu

Sarah McHugh

Role: primary

smchugh@fgcinc.org

References

Becker SJ, DiClemente-Bosco K, Scott K, Janssen T, Salino SM, Hasan FN, Yap KR, Garner BR. Implementing contingency management for stimulant use in opioid treatment programs: protocol of a type III hybrid effectiveness-stepped-wedge trial. Implement Sci. 2023 Sep 13;18(1):41. doi: 10.1186/s13012-023-01297-w.

Reference Type: DERIVED

PMID: 37705093 (View on PubMed)

Other Identifiers

P50DA054072

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STU00217287

Identifier Type: -

Identifier Source: org_study_id