Dissemination of Contingency Management for the Treatment of Opioid Use Disorder
Phone apps that pay for drug-free tests are ready to scale once clinics secure payment codes.
01Research in Context
What this study did
DeFulio (2023) looked at smartphone apps that pay people small rewards for staying off opioids. The paper is a narrative review, not a new experiment. It pulls together policy, cost, and legal issues that block wide use of these apps.
The goal was to see if the science is strong enough to roll the apps out everywhere. The author says yes, once billing and red tape are fixed.
What they found
The review finds that phone-based contingency management works and no longer needs staff to run it. The tech is ready. The hold-ups are money and Medicaid codes, not training or client data.
In short, the behavior part is solved; the payment part is not.
How this fits with other research
Moss et al. (2020) already showed a digital points card boosted treatment finish 1.5 times in real clinics. DeFulio extends that idea by saying smartphones can now do the same job without a clinic worker holding the card.
Stinson et al. (2023) used the same phone-reward setup to cut college students’ social media use. Both studies show the tech works across very different habits, giving extra proof the method is solid.
SWilson et al. (2023) wrote a rollout plan for stimulant users in opioid programs. Their paper and DeFulio’s both target the same clinics, but SJ focus on staff training while DeFulio says training is no longer the issue. The views seem opposite, yet they fit: SJ prepare staff for face-to-face CM, DeFulio argues phone CM can skip that step.
Why it matters
If you work with adults on medication for opioid use, you can now add an app that pays for clean drug tests without extra staff hours. Push for pay codes or grant funds instead of more training. Start small: pick one app, track cost against treatment gains, and share the numbers with your funders.
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02At a glance
03Original abstract
Contingency management is an intervention for substance use disorders based on operant principles. The evidence base in support of contingency management is massive. It is effective in treating substance use disorder in general and opioid use disorder in particular. Dissemination has remained slow despite the urgency created by the opioid epidemic. Key barriers include a lack of expertise, time, and money. Implementing contingency management with smartphones eliminates the need for special training. It also solves logistical issues and requires little time on the part of clinicians. Thus, remaining barriers relate to cost. Federal anti-kickback regulations complicate solutions to the cost barrier. Other important regulatory challenges related to cost include the lack of billing codes and the difficulty of obtaining FDA approval for digital therapeutics. Even after the cost barrier is overcome, provider adoption is not guaranteed. Incentivizing providers for collaborative care may increase adoption and generate referrals. Recently proposed legislation and governmental policy statements provide optimism regarding the near-term large-scale adoption of contingency management in the treatment of opioid use disorder.
Perspectives on Behavior Science, 2023 · doi:10.1007/s40614-022-00328-z