Effective, but underused: lessons learned implementing contingency management in real-world practice settings in the United States

Despite being one of the most effective adjunctive behavioral interventions in combination with medication for opioid use disorder, contingency management (CM) is one of the least available interventions in opioid treatment programs. This paradoxical state of affairs is perhaps the greatest example...

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Veröffentlicht in:Preventive medicine Jg. 176; S. 107594
Hauptverfasser: Becker, Sara J., DiClemente-Bosco, Kira, Rash, Carla J., Garner, Bryan R.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.11.2023
Schlagworte:
Addiction technology transfer center
Analgesics, Opioid
Behavior Therapy
Contingency management
Humans
Implementation
Incentives
Internal Medicine
Lessons
Motivation
Opioid-Related Disorders - drug therapy
Opioid-Related Disorders - prevention & control
Training
United States
United States
Training
Incentives
Addiction technology transfer center
Contingency management
Lessons
CM
OTP
VA
ATTC
Implementation
Opioid treatment programs
Veterans Affairs
ISSN:0091-7435, 1096-0260, 1096-0260
Online-Zugang:Volltext
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Zusammenfassung:Despite being one of the most effective adjunctive behavioral interventions in combination with medication for opioid use disorder, contingency management (CM) is one of the least available interventions in opioid treatment programs. This paradoxical state of affairs is perhaps the greatest example of the research-to-practice gap in the behavioral health field. Implementation science, a discipline that aims to identify replicable methods that can be used across settings and populations to bridge the gap between research and practice, can potentially help. Based on our team's experience implementing CM in opioid treatment programs, we detail five key lessons for researchers, clinicians, policy makers, and others seeking to implement and sustain CM in real-world settings. First, multiple barriers to CM implementation exist at both the counselor- and organization-levels, requiring multi-level solutions. Second, one-shot CM training alone is not sufficient for successful implementation: ongoing support is essential to achieve levels of intervention fidelity that will benefit patients. Third, assessing an organization's capacity for implementation prior to support provision can prevent costly mistakes. Fourth, implementors should plan for high staff turnover rates and expect the unexpected by developing detailed contingency plans. Finally, implementors should remember that the goal is to implement evidence-based CM and not simply incentives. We encourage colleagues to consider these lessons to increase the likelihood that CM can be implemented and sustained in a manner that improves the quality of care in opioid treatment programs. •Contingency management (CM) is effective yet underused in opioid treatment programs•Implementation of CM requires multi-level, ongoing strategies•Opioid treatment programs' basic needs must be met first before adding CM•Implementors should expect the unexpected and develop detailed contingency plans•Providing evidence-based CM is the goal, not simply incentives
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AUTHOR CONTRIBUTIONS
Sara Becker, PhD, was the Principal Investigator of two NIDA grants (R01DA046941 and P50DA054072) and a SAMHSA grant (UR1TI080209) that inspired this article. Dr. Becker led the conceptualization of this article and wrote a complete first original draft. Bryan Garner is Multiple Principal Investigator on R01DA046941 and Co-Investigator on P50DA054072, and Drs. DiClemente-Bosco and Rash are Co-Investigators on both grants. All co-authors engaged in multiple brainstorming and debriefing sessions over the past several years that directly led to the lessons in this manuscript, and all co-authors provided critical review of the manuscript, made multiple rounds of revisions, and approved the final version.
ISSN:0091-7435
1096-0260
1096-0260
DOI:10.1016/j.ypmed.2023.107594