Encouraging Abstinence Behavior in a Drug Epidemic: Optimizing Dynamic Incentives

Recruiting now · Not applicable · Has a placebo group

Conditions studied: Opioid-use Disorder, Cocaine Use Disorder, Opioid Use, Cocaine Use, Substance Use, Methamphetamine Abuse, Methamphetamine-dependence

In brief

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.

Key facts

Study ID: NCT04927143
Run by: Wake Forest University Health Sciences
People needed: 600
Starts: 2021-09-15
Expected to finish: 2026-09-01
Last updated by the study team: 2026-02-12

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

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 contingency management because at least ONE of the following conditions is true:
Were first enrolled in residential, PHP, or IOP substance use treatment no longer than 2 treatment weeks (14 days/encounters of treatment) prior to providing informed consent.
Used non-medical opioids, cocaine, and/or methamphetamine within the last 21 days.
Understands English.

You may not qualify if…

Have evidence of active (non-substance related) psychosis that might impair participation as determined by the PI.
Has significant cognitive impairment that might confound participation as determined by the PI or are so significantly cognitively impaired that they have a legal guardian.

Where it is running

Rogers Behavioral Health — Oconomowoc, Wisconsin, United States (enrolling)
Advocate Aurora Behavioral Health Services — Wauwatosa, Wisconsin, United States (enrolling)

Full record on ClinicalTrials.gov

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