Encouraging Abstinence Behavior in a Drug Epidemic: Optimizing Dynamic Incentives

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.

Conditions

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

Interventions

BEHAVIORAL

Sham Control

Participants get access to the DynamiCare app but will not be provided with financial incentives.

BEHAVIORAL

App-Based Contingency Management

Participants will receive financial incentives for submitting randomly generated drug-negative saliva tests across the intervention period.

Sponsors & Collaborators

• University of Chicago

  collaborator OTHER

• Rogers Behavioral Health

  collaborator OTHER

• University of California Santa Cruz

  collaborator OTHER

• Wake Forest University Health Sciences

  lead OTHER

Principal Investigators

• Mercedes Robaina, PhD · Advocate Aurora Behavioral Health Services

• Ariel Zucker, PhD · University of California Santa Cruz

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-09-15

Primary Completion

2026-09-30

Completion

2026-09-30

Countries

• United States

Study Locations