Brief 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.

Trial Health

On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment

600

participants targeted

Target at P75+ for not_applicable

Timeline

3mo left

Started Sep 2021

Longer than P75 for not_applicable

Geographic Reach

1 country

2 active sites

Status

recruiting

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

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Study Timeline

Key milestones and dates

5 years study duration

Study Progress94%

Sep 2021Sep 2026

First Submitted

Initial submission to the registry

June 9, 2021

Completed

6 days until next milestone

First Posted

Study publicly available on registry

June 15, 2021

Completed

3 months until next milestone

Study Start

First participant enrolled

September 15, 2021

Completed

5 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

September 1, 2026

Expected

Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

September 1, 2026

Last Updated

February 12, 2026

Status Verified

February 1, 2026

Enrollment Period

5 years

First QC Date

June 9, 2021

Last Update Submit

February 9, 2026

Conditions

Opioid-use Disorder Cocaine Use Disorder Opioid Use Cocaine Use Substance Use Methamphetamine Abuse Methamphetamine-dependence

Keywords

contingency managementapp-based treatment

Outcome Measures

Primary Outcomes (2)

Percent of Negative Saliva Tests
Percent of tests negative for non-medical opioids, cocaine, or stimulant
month 3
Percent of App Acceptability
Percent of eligible population which accepts app
month 12

Secondary Outcomes (4)

Percent of Psychotherapy Visits Attended
month 3
Percent of Treatment Discharge Against Medical Advice
month 3
Percent of Relapse
month 3
Percent of transition to step-down care
Day 14

Study Arms (7)

Control

ACTIVE COMPARATOR

Participants in this group will have access to the DynamiCare app; however, no behavioral incentives will be provided to this group.

Behavioral: Sham Control

Escalating Low

EXPERIMENTAL

Participants will have access to the DynamiCare app. Through the app, participants will receive incentive amounts for drug negative saliva tests. Incentive amounts increase with every negative drug test up to a ceiling and "reset" to the lowest amount when a test is positive or missed. The "Low" group will receive incentives worth $2-$8.