C-DIAS RP 2: Implementing contingency management for stimulant use in specialty addiction treatment organizations

C-DIAS RESEARCH PROJECT 2: PROJECT SUMMARY/ABSTRACT
This rigorous experiment addresses a critical public health problem--the rising stimulant/opioid epidemic. It
advances implementation science through the evaluation of a multi-level implementation strategy and specifies
of contextual determinants of outcomes. Stimulants constitute a new and deadly fourth wave of the opioid
epidemic. Among persons with opioid use disorder, stimulant use has been associated with more persistent
opioid use; higher risk of HIV infection; higher levels of family, medical, legal, and vocational problems; and
higher risk of lethal overdose. Contingency management (CM) is the most effective intervention for stimulant
use and is an evidence-based adjunct to medication for opioid use disorder (MOUD). Yet, uptake of CM in
opioid treatment programs (OTPs) that provide MOUD remains low: in fact, access to CM is arguably one of
the greatest research-to-practice gaps in the addiction treatment services field. The goal of C-DIAS Research
Project 2 is to conduct a type III hybrid effectiveness-implementation trial to evaluate a multi-level
implementation strategy, the Science to Service Laboratory (SSL), to install CM for stimulant use in OTPs. The
SSL has three core components: didactic training; performance feedback; and external facilitation. The project
employs common C-DIAS frameworks, measures, and methods to guide SSL evaluation. Utilizing a stepped
wedge design, a regional cohort of 10 public sector OTPs will be randomized to receive SSL at five distinct
time points. At six intervals, each of the 10 OTPs will provide data from all available patient charts on CM
delivery and patient outcomes. Each OTP will also recruit 10 patients per wedge (n = 500 patients) to complete
a baseline interview and 3-month follow-up. In addition, staff from each OTP will report on contextual
determinants of implementation outcomes at three timepoints. This study will rigorously evaluate whether a
multi-level implementation strategy developed by one of the longest-standing national intermediary purveyor
organizations--the SAMHSA Technology Transfer Centers, will improve both implementation and patient
outcomes. Implementation outcomes are guided by RE-AIM and include CM Reach, Adoption, Implementation
and Sustainment, while patient outcomes include measures of CM Effectiveness such as stimulant abstinence
and treatment retention. The study will advance the C-DIAS scientific aims by unpacking the black box of
implementation strategies and exploring the mediational and moderating influence of context on
implementation outcomes. Focused on the active IMPLEMENT phase, this Research Project leverages a bi-
directional synergistic relationship with C-DIAS. Some but not all examples of this include: 1) standardized
measures of implementation context, outcomes and procedural details of strategies; 2) PI (Becker)’s role on
the C-DIAS Research Core; 3) a close network of collaboration and mentoring among the key project
personnel and C-DIAS PI; and 4) harmonization of data that can be used for modeling by C-DIAS Research
Core experts.

Grant Number: 5P50DA054072-04
NIH Institute/Center: NIH
Principal Investigator: Sara Becker