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Published, Version of Record (VoR)CC BY V4.0, Open
Journal article
Implementation of contingency management with women engaging in polysubstance use
Addiction science & clinical practice, v 20(1), 63
08 Aug 2025
PMID: 40781335
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background
Contingency management (CM) is an effective intervention that provides financial incentives as positive reinforcement for reducing opioid or stimulant use. However, it has not been tested in populations of women who inject drugs (WWID) engaging in polysubstance use.
Methods
We aimed to compare the feasibility of two CM protocols designed to encourage illicit stimulant and opioid abstinence among WWID participating in an ongoing HIV prevention trial. Participants completed a 3-month CM period during which they submitted thrice weekly urine toxicology screenings (UTOX). In the 'abstinence from stimulants and opioids' protocol, participants received a $5 USD incentive when metabolites of stimulants and opioids were not detected in urine. In the 'partial-abstinence protocol', they received a $5 USD incentive when metabolites of stimulants or opioids were not detected, thus doubling the potential incentive obtained each visit. Women also received scaling bonuses after three consecutive negative UTOX ($5-$15 USD). We used descriptive statistics to summarize the total number of (1) UTOXs completed and (2) bonuses distributed. Rates of engagement per person per month were calculated (i.e., total number of completed UTOX/3 months*24 participants). Rates of engagement were compared by CM protocol period.
Results
Participants were primarily White women (67%) with an average age of 47 years. Self-reported polysubstance use was common (96%) with women reporting injecting an average of 5 times daily (Interquartile Range: 2-7). Participants (N = 24) collectively submitted 177 UTOX during their 3-month CM periods. Rates of non-reactive UTOX results were slightly higher in the partial-abstinence protocol compared to the abstinence from stimulants and opioids protocol (2.9 per month versus 1.0 per month). More bonuses were earned in the partial-abstinence protocol (0.50 bonuses per participant per month) compared to the abstinence from stimulants and opioids protocol (none). There were no study related adverse events in either protocol group during the CM period.
Conclusions
Findings demonstrate the feasibility of a CM protocol that provided financial incentives for partial abstinence, periods with documented stimulant or opioid abstinence, as well as abstinence to both, without the occurrence of iatrogenic effects. Future research focusing on CM protocols with more flexible incentive structures remains critical.
Trial registration NCT05192434.
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Details
- Title
- Implementation of contingency management with women engaging in polysubstance use
- Creators
- Kathleen M. Ward - Drexel University, Community Health and PreventionAdam W. Carrico - University of MiamiDaniel Vader - Drexel University, Epidemiology and BiostatisticsRenee H. Moore - Drexel University, Epidemiology and BiostatisticsK. Rivet Amico - University of MichiganAllison K. Groves - Drexel University, Community Health and PreventionScarlett L. Bellamy - Drexel University, Epidemiology and BiostatisticsSusan G. Sherman - Johns Hopkins UniversityDouglas Krakower - Harvard UniversitySilvana MazzellaAlexis M. Roth (Corresponding Author) - Drexel University, Community Health and Prevention
- Publication Details
- Addiction science & clinical practice, v 20(1), 63
- Publisher
- Springer Nature
- Number of pages
- 7
- Grant note
- We would like to thank the participants, the TIARAS research staff, the medical reception team, and HIV-related services providers at Prevention Point Philadelphia. Funding This research and manuscript were supported by National Institutes of Health R01DA054543 (AMR). United States Department of Health & Human Services; NIH National Institute on Drug Abuse (NIDA)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics; Community Health and Prevention
- Web of Science ID
- WOS:001546042700002
- Scopus ID
- 2-s2.0-105012895925
- Other Identifier
- 991022073152904721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Substance Abuse