Implementing contingency management for stimulant use in opioid treatment programs: protocol of a type III hybrid effectiveness-stepped-wedge trial.
A new coaching package may soon show how to get contingency management for stimulant use running in everyday opioid clinics.
01Research in Context
What this study did
SWilson et al. (2023) wrote a plan for a stepped-wedge trial. They will test if the Science of Service Laboratory helps clinics start contingency management for stimulant use.
The lab gives staff short lessons, weekly feedback, and outside coaching. The trial will roll out in opioid treatment programs across several states.
What they found
This paper is only a protocol. No patient results are ready yet.
How this fits with other research
Moss et al. (2020) already showed a digital points card boosted treatment completion 1.5 times in addiction clinics. SJ’s plan builds on that success by adding coaching so more clinics can copy it.
DeFulio (2023) says smartphone contingency management works and needs no extra staff training. SJ’s plan seems to disagree because it adds training and coaching. The gap is setting: DeFulio targets phone apps that run themselves, while SJ targets clinics that still need staff to hand out vouchers.
Pickering et al. (1985) proved contingency management beats pills for problem behavior. SJ’s trial moves the same idea into adult stimulant care forty years later.
Why it matters
If the coaching package works, you can ask your opioid program to adopt it without building a new app. Watch for the full results in a year or two.
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02At a glance
03Original abstract
<h4>Background</h4>Contingency management (CM) is an evidence-based intervention for stimulant use and is highly effective in combination with medication for opioid use disorder. Yet, uptake of CM in opioid treatment programs that provide medication for opioid use disorder remains low. This paradox in which CM is one of the most effective interventions, yet one of the least available, represents one of the greatest research-to-practice gaps in the addiction health services field. Multi-level implementation strategies are needed to address barriers to CM implementation at both the provider- and organization-level. This type III hybrid effectiveness-implementation trial was funded by the National Institute on Drug Abuse to evaluate whether a multi-level implementation strategy, the Science of Service Laboratory (SSL), can effectively promote CM implementation in opioid treatment programs. Specific aims will test the effectiveness of the SSL on implementation outcomes (primary aim) and patient outcomes (secondary aim), as well as test putative mediators of implementation outcomes (exploratory aim).<h4>Methods</h4>Utilizing a fully powered type III hybrid effectiveness-implementation trial with a stepped wedge design, we propose to randomize a cohort of 10 opioid treatment programs to receive the SSL across four steps. Each step, an additional 2-3 opioid treatment programs will receive the SSL implementation strategy, which has three core components: didactic training, performance feedback, and external facilitation. At six intervals, each of the 10 opioid treatment programs will provide de-identified electronic medical record data from all available patient charts on CM delivery and patient outcomes. Staff from each opioid treatment program will provide feedback on contextual determinants influencing implementation at three timepoints.<h4>Discussion</h4>Between planning of this protocol and receipt of funding, the landscape for CM in the USA changed dramatically, with multiple Departments of Health launching state-wide CM initiatives. We therefore accelerated the protocol timeline and offered some cursory training resources to all sites as a preparation activity. We also began partnering with multiple Departments of Health to evaluate their rollout of CM using the measures outlined in this protocol.<h4>Trial registration</h4>This study protocol is registered via ClinicalTrials.gov Identifier: NCT05702021. Date of registration: January 27, 2023.
, 2023 · doi:10.1186/s13012-023-01297-w