Contingency Management + Coaching for Substance Use Disorders
(PEERS Trial)
Recruiting in Palo Alto (17 mi)
+1 other location
Age: 18 - 65
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Chestnut Health Systems
Disqualifiers: Federal disability, Unhoused, Life threatening condition
No Placebo Group
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.
12345Is 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.
12467How 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.
12489Eligibility 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
+1 more
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)
+1 more
Trial 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
Participant Groups
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.
2Treatment groups
Experimental Treatment
Active Control
Group I: CM combined with Vocational/educational Coaching from Coaches without Lived ExperienceExperimental Treatment1 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 ExperienceActive Control1 Intervention
This group will receive contingency management (CM) combined with vocational/educational coaching from paraprofessional coaches with lived experience in community settings.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Oregon Social Learning CenterEugene, OR
Chestnut Health SystemsEugene, OR
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Who Is Running the Clinical Trial?
Chestnut Health SystemsLead Sponsor
Oregon Social Learning CenterLead Sponsor
National Institute on Drug Abuse (NIDA)Collaborator
References
Vouchers versus prizes: contingency management treatment of substance abusers in community settings. [2016]Contingency management (CM) interventions usually use vouchers as reinforcers, but a new technique awards chances of winning prizes. This study compares these approaches. In community treatment centers, 142 cocaine- or heroin-dependent outpatients were randomly assigned to standard treatment (ST), ST with vouchers, or ST with prizes for 12 weeks. CM patients remained in treatment longer and achieved greater durations of objectively confirmed abstinence than did ST patients; CM conditions did not differ significantly. Although abstinence at 6- and 9-month follow-ups did not differ by group, the best predictor of abstinence was longest duration of abstinence achieved during treatment. Thus, prize and voucher CM systems are equally efficacious in promoting long durations of abstinence, which in turn are associated with benefits posttreatment.
Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. [2021]Contingency management (CM) interventions frequently utilize vouchers as reinforcers, but a prize-based system is also efficacious. This study compared these approaches. Seventy-four cocaine-dependent methadone outpatients were randomly assigned to standard treatment (ST), ST plus a maximum of $585 in contingent vouchers, or ST plus an expected average maximum of $300 in contingent prizes for 12 weeks. CM participants achieved longer durations of abstinence (LDA) than ST participants, and CM conditions did not differ significantly in outcomes or amount of reinforcement earned. Although long-term abstinence did not differ by group, LDA during treatment was the best predictor of abstinence at 9 months. Thus, reinforcement with prizes was similar to voucher CM in promoting LDA, which is associated with posttreatment benefits.
Give them prizes, and they will come: contingency management for treatment of alcohol dependence. [2022]This study evaluated the efficacy of a contingency management (CM) procedure that provided opportunities to win prizes as reinforcers. At intake to outpatient treatment, 42 alcohol-dependent veterans were randomly assigned to receive standard treatment or standard treatment plus CM, in which they earned the chance to win prizes for submitting negative Breathalyzer samples and completing steps toward treatment goals. Eighty-four percent of the CM participants were retained in treatment for an 8-week period compared with 22% of the standard treatment participants (p
Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis. [2021]Contingency management (CM) is a treatment for substance misuse that involves the provision of incentives. This review examines the hypothesis that adding another formal psychotherapy, such as cognitive-behavioural therapy (CBT) or motivational enhancement therapy (MET), to CM improves substance use outcomes at both treatment end and at post-treatment follow-up compared with CM only.
Examining implementation of contingency management in real-world settings. [2021]Very little is known about how reward programs are implemented in real-world substance use treatment settings and whether training in contingency management (CM), an empirically supported rewards-based intervention, impacts their design quality. Providers (N = 214) completed surveys assessing CM beliefs, training, and practices related to use of tangible rewards in treatment. For providers reporting they had not used rewards in treatment previously (54%, n = 116), we assessed beliefs about and interest in adopting a reward-based program. For those endorsing prior reward experience (46%, n = 98), we assessed the features and delivery of rewards and the relation of reward-based intervention training to 4 parameters related to CM efficacy: reinforcement magnitude, immediacy, frequency, and escalation. Among providers without reward experience, endorsement of supportive statements about CM predicted interest in adopting a rewards-based program. Providers with reward experience most often targeted treatment attendance and engaged in behaviors likely to decrease the effectiveness of the intervention, including use of low magnitudes (≤ $25/client), delayed reinforcement, failure to escalate reward values, and offering reward opportunities less than weekly. Providers with longer durations of training were more likely to engage in behaviors consistent with effective CM, including larger magnitude rewards and immediate delivery of rewards. Results indicate that real-world treatment clinics are using reward-based programs but not in ways consistent with research protocols. Longer training exposure is associated with greater adherence to some aspects of CM protocol design. Other evidence-based design features are not being implemented as recommended, even with training. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Contingency management in cocaine abusers: a dose-effect comparison of goods-based versus cash-based incentives. [2022]Goods-based contingency management interventions (e.g., those using vouchers or prizes as incentives) have demonstrated efficacy in reducing cocaine use, but cost has limited dissemination to community clinics. Recent research suggests that development of a cash-based contingency management approach may improve treatment outcomes while reducing operational costs of the intervention. However, the clinical safety of providing cash-based incentives to substance abusers has been a concern. The present 16-week study compared the effects of goods-based versus cash-based incentives worth $0, $25, $50, and $100 on short-term cocaine abstinence in a small sample of cocaine-dependent methadone patients (N = 12). A within-subject design was used; a 9-day washout period separated each of 8 incentive conditions. Higher magnitude ($50 and $100) cash-based incentives (checks) produced greater cocaine abstinence compared with the control ($0) condition, but a magnitude effect was not seen for goods-based incentives (vouchers). A trend was observed for greater rates of abstinence in the cash-based versus goods-based incentives at the $50 and $100 magnitudes. Receipt of $100 checks did not increase subsequent rates of cocaine use above those seen in control conditions. The efficacy and safety data provided in this and other recent studies suggest that use of cash-based incentives deserves consideration for clinical applications of contingency management, but additional confirmation in research using larger samples and more prolonged periods of incentive delivery is needed.
Motivation and Contingency Management Treatments for Substance Use Disorders. [2016]Contingency management (CM) is a highly efficacious psychosocial treatment for substance use disorders based on the principles of behavioral analysis. CM involves delivering a tangible positive reinforcer following objective evidence of submission of a drug-negative urine sample. Although CM interventions primarily involve applying extrinsic rewards, a patient's intrinsic motivation to change substance use behavior may also be impacted by CM. This chapter provides an introduction to CM interventions for substance use disorders and examines the impact of CM on intrinsic motivation . It also addresses applications of this intervention to other conditions and patient populations.
Contingency management for treatment of substance abuse. [2019]Clinical research trials demonstrate the efficacy of contingency management procedures in treating substance use disorders. Usually, reinforcement, in the form of vouchers exchangeable for retail goods and services, is provided for drug abstinence in patients treated in psychosocial or methadone maintenance clinics. Recently, the types of reinforcers have been adapted to include lower cost alternatives, and reinforcement is being expanded to alter other target behaviors such as attendance at treatment, adherence to treatment goals, and compliance with medication. This chapter provides an overview of the populations and behaviors to which contingency management approaches have been applied. It also reviews design features that appear critical in the successful adaptation of the techniques. In addition, areas for future research are described.
Implementing an evidence-based prize contingency management protocol for stimulant use. [2023]Contingency management (CM) is an efficacious treatment for stimulant use disorders. Support materials for the clinical delivery of prize-based CM are widely accessible, but few resources are available to support design and preparation for CM implementation. This guide aims to fill that gap.