Encouraging Abstinence Behavior in a Drug Epidemic: Optimizing Dynamic Incentives
Wake Forest University Health Sciences
Summary
Combatting the rise of the opioid epidemic is a central challenge of U.S. health care policy. A promising approach for improving welfare and decreasing medical costs of people with substance abuse disorders is offering incentive payments for healthy behaviors. This approach, broadly known as "contingency management" in the medical literature, has repeatedly shown to be effective in treating substance abuse. However, the use of incentives by treatment facilities remains extremely low. Furthermore, it is not well understood how to design optimal incentives to treat opioid abuse. This project will conduct a randomized evaluation of two types of dynamically adjusting incentive schedules for people with opioid use disorders or cocaine use disorders: "escalating" schedules where incentive amounts increase with success to increase incentive power, and "de-escalating" schedules where incentive amounts decrease with success to improve incentive targeting. Both schemes are implemented with a novel "turnkey" mobile application, making them uniquely low-cost, low-hassle, and scalable. Effects will be measured on abstinence outcomes, including longest duration of abstinence and the percentage of negative drug tests. In combination with survey data, variation from the experiment will shed light on the barriers to abstinence more broadly and inform the understanding of optimal incentive design.
Description
Over the past decade, the annual number of drug-related deaths more than doubled in the United States (Swensen, 2015). In particular, over the 2001-2013 period, overdose deaths involving prescription pain relievers tripled while those involving heroin increased fivefold (NIDA, 2015). Further, the COVID-19 pandemic is thought to have significantly increased drug use, especially opioids, cocaine, and methamphetamines. This upward-sloping trend has steepened in the past few years. Drug overdoses are now the principal cause of death among Americans aged less than 50. A primary cause of this escala…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Age at least 18 years old; * Meet DSM-5 OUD, CoUD, or MUD criteria as evidenced by an OUD CPT code F11\* (opioid related disorders), a CoUD CPT code F14\* (cocaine related disorders), a MUD CPT code F15.1/F15.2 or other clinical notes indicating illicit opioid/cocaine/methamphetamine use for treatment * Have access to a smartphone (iOS or Android) with data plan and willing to download DynamiCare app; * Have an email and can access it from their smartphone; * Are in residential, day (PHP), partial day (IOP), or outpatient (OP) AODA treatment; * Are likely to be helped by…
Interventions
- BehavioralApp-Based Contingency Management
Participants will receive financial incentives for submitting randomly generated drug-negative saliva tests across the intervention period.
- BehavioralSham Control
Participants get access to the DynamiCare app but will not be provided with financial incentives.
Locations (2)
- Rogers Behavioral HealthOconomowoc, Wisconsin
- Advocate Aurora Behavioral Health ServicesWauwatosa, Wisconsin