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Recovery incentives program: California's contingency management benefit

The role of methamphetamine and cocaine use in California's drug poisoning (overdose) crisis has dramatically increased in the past five (5) years and has disproportionately affected American Indian, Alaska Native, and Black Californians. No FDA-approved medications currently exist for the trea...

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Bibliographic Details
Published in:Preventive medicine 2023-11, Vol.176, p.107703-107703, Article 107703
Main Authors: Freese, Thomas E., Rutkowski, Beth A., Peck, James A., Urada, Darren, Clark, H. Westley, Bland, Anton Nigusse, Friedman, Joseph, Rawson, Richard A.
Format: Article
Language:English
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Summary:The role of methamphetamine and cocaine use in California's drug poisoning (overdose) crisis has dramatically increased in the past five (5) years and has disproportionately affected American Indian, Alaska Native, and Black Californians. No FDA-approved medications currently exist for the treatment of individuals with stimulant use disorder (StimUD). Outside the Veteran's Administration, the Recovery Incentives Program: California's Contingency Management Benefit is the first large scale implementation of contingency management (CM). CM is the behavioral treatment with the most evidence and largest effect sizes for StimUD. The Program uses a CM protocol where participants can receive a maximum of $599 over a six-month period, contingent upon 36 stimulant-negative urine test results. Urine tests are conducted using a set of approved, CLIA-waived, point-of-care urine drug tests (UDTs). To ensure fidelity to the CM protocol and to prevent fraud, waste, and abuse, all aspects of incentive accounting and distribution are managed electronically via a custom-developed software system. Incentive distribution utilizes electronic gift cards. A significant innovation of the project is the conceptualization of the CM Coordinator, a designated and highly trained and supervised individual responsible for all aspects of CM operation in a specific site. The California Department of Health Care Services contracted with UCLA to develop and implement a robust evaluation of the Program; goals include evaluating the effectiveness of real-world implementation and facilitating quality improvement. The project will likely significantly impact the use of CM for StimUD nationally and may well reduce stimulant-related drug poisoning deaths. •California is piloting Medicaid funded Contingency Management in outpatient sites.•Comprehensive training/support is critical to successful real-world implementation.•Pilot uses a robust protocol based on 30+ years of research with stimulant use.•Program evaluation will highlight barriers/facilitators to implementation of CM.•Using dedicated CM Coordinators to conduct service enhances protocol adherence.
ISSN:0091-7435
1096-0260
DOI:10.1016/j.ypmed.2023.107703