Implementing Contingency Management for Stimulant Use in Specialty Addiction Treatment Organizations (MIMIC2)

Implementing Contingency Management for Stimulant Use in Specialty Addiction Treatment Organizations (Center for Dissemination and Implementation Science at Stanford, Research Component #2)

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 cohort of public sector addiction specialty treatment programs will be randomized to receive Science of Service Laboratory across four cohorts. Each of the programs will provide de-identified electronic medical record data from all available patient charts on contingency management delivery and patient outcomes. Staff from each 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.

Study Overview

• Status: Recruiting
• Conditions: Stimulant Use (Diagnosis)
• Intervention / Treatment: Behavioral: Science to Service Laboratory

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 type III hybrid effectiveness-implementation trial with a stepped wedge design, we will enroll public sector addiction specialty programs across two states (Rhode Island and Illinois) to receive the Science of Service Laboratory. Data collection will leverage multiple sources. Programs will be enrolled across 4 cohorts - 1 in Rhode Island and 3 in Illinois. Each program will receive the multi-level Science to Service Laboratory and will extract de-identified electronic medical record data on contingency management implementation and patient outcomes. In addition, 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 advance 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.

• Study Type: Interventional
• Enrollment (Estimated): 76
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Sara Becker; Phone Number: 312-503-1709; Email: Sara.becker@northwestern.edu
• Study Contact Backup: Name: Kira DiClemente-Bosco

Study Locations

• United States
  • Illinois
    • Chicago, Illinois, United States, 60609
      • Recruiting
      • ACCESS Community Health Networks
      • Contact: Ashland Family Center; Phone Number: 773-434-9216
    • Chicago, Illinois, United States, 60623
      • Completed
      • Lawndale Christian Health Center
    • Chicago, Illinois, United States, 60651
      • Completed
      • Healthcare Alternative Systems
    • Chicago, Illinois, United States, 60654
      • Recruiting
      • Community Outreach Intervention Projects
      • Contact: Mobile Outreach; Phone Number: 312-785-7195
    • Chicago, Illinois, United States, 60654
      • Recruiting
      • Family Guidance Centers
      • Contact: Central Intake; Phone Number: 844-834-2227
    • Rockford, Illinois, United States, 61108
      • Recruiting
      • Rosecrance Health Network
      • Contact: Rosecrance Harrison; Phone Number: 815-335-9798
  • Rhode Island
    • Pawtucket, Rhode Island, United States, 02860
      • Completed
      • Addiction Recovery Institute
    • Providence, Rhode Island, United States, 02905
      • Completed
      • Comprehensive Treatment Centers
    • Providence, Rhode Island, United States, 02909
      • Completed
      • CODAC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

• Opioid Treatment Program Counselors:

  • Inclusion criteria: 1) provide ongoing psychosocial support to medication for opioid use disorder patients (e.g., intake sessions, individual counseling, and/or group counseling sessions), and 2) have an active caseload
  • Exclusion criteria: Younger than 18 years of age, unable to provide informed consent

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

  • Inclusion criteria: must be newly initiated on medication for opioid use disorders (within the past 30 days) and have concurrent stimulant use (indicated by self-report of past 30-day stimulant use or positive toxicology screen within 30 days).
  • Exclusion criteria: Younger than 18 years of age, Does not have electronic medical records

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 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).	Behavioral: 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).
No Intervention: 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in percent of patients receiving contingency management from pre-implementation to post-implementation	This is an implementation outcome capturing Reach and is extracted from electronic medical records. This is a patient-level measure of the change in the percent of newly inducted patients with a history of stimulant use who are documented as having received 1 or more contingency management sessions from pre-implementation to post-implementation.	10 months
Change in percent of counselors delivering contingency management from pre-implementation to post-implementation	This is an implementation outcome capturing Adoption and is extracted from electronic medical records. This is a provider-level measure of the change in percent of counselors at each program who are documented as having delivered 1 or more contingency management sessions from pre-implementation to post-implementation.	10 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in the percent of toxicology screens negative for stimulants	This is a patient-level outcome measuring Stimulant Abstinence and is extracted from electronic medical records. This measures the change in percent of toxicology screens that are negative for stimulants from pre-implementation to post-implementation.	10 months
Change in number of contingency management sessions	This is a patient-level outcome measuring Contingency Management Treatment Retention and is extracted from electronic medical records. This measures the change in the number of contingency management sessions received per patient from pre-implementation to post-implementation.	10 months

Collaborators and Investigators

• Sponsor: Northwestern University
• Collaborators: National Institute on Drug Abuse (NIDA); Stanford University; Ohio State University
• Investigators: Principal Investigator: Sara Becker, Northwestern University

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (Actual): June 7, 2023
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): August 1, 2027

Study Registration Dates

• First Submitted: January 11, 2023
• First Submitted That Met QC Criteria: January 26, 2023
• First Posted (Actual): January 27, 2023

Study Record Updates

• Last Update Posted (Actual): May 1, 2026
• Last Update Submitted That Met QC Criteria: April 27, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Opioid Use Disorder; Stimulants; Behavior change; Implementation science; Contingency management
• Additional Relevant MeSH Terms: Narcotic-Related Disorders; Mental Disorders; Pathologic Processes; Substance-Related Disorders; Chemically-Induced Disorders; Pathological Conditions, Signs and Symptoms; Opioid-Related Disorders; Disease
• Other Study ID Numbers: STU00217287; P50DA054072 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: This study protocol is embedded within a Center of Excellence funded by the National Institute on Drug Abuse. In coordination with other center project components, the study protocol and statistical analysis plan for primary outcomes will be submitted for publication to either an addiction (e.g., Addiction, Journal of Substance Abuse Treatment) or implementation science (e.g., Implementation Science, Implementation Science: Research and Practice) journal. Additional data (analytic code, participant-level data) can be requested from the Principal Investigator. Analysis files will be constructed from the electronic data and will be stripped of identifying information. Specifically, participants will be identified with a numeric identifier that is not related to any element of their personal identifying information. No names, addresses, telephone numbers, email addresses, medical record numbers, etc. will be retained in the de-identified files.
• IPD Sharing Time Frame: Protocol will be submitted for publication in coordination with other project components, with a target submission date in 2023. Analytic code and participant-level data will be made ready for distribution within 12 months of study completion.
• IPD Sharing Access Criteria: Data will only be shared with external investigators when a data use agreement (DUA) is executed between Northwestern University and the requester's institution. The DUA will specify the requested data elements (each of which must be justified), the specific research question, the timeline for the project, and schedule for data destruction.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No