Enhancing Motivation, MAT Adherence & Retention with Routine Use of Contingency Management

Registration deadline 1/26/23

Trainer: David Gastfriend M.D., DFASAM

Dr. Gastfriend is an addiction psychiatrist. At Harvard Medical School, he directed addiction research at Massachusetts General Hospital and was an investigator in the NIDA Cocaine Collaborative Study, NIAAA’s COMBINE Study and NIDA’s Clinical Trials Network. As Vice President at Alkermes, Inc., he directed scientific publications on Vivitrol in clinical, criminal justice and health economics research.
His research led most states to endorse the American Society of Addiction Medicine (ASAM) Criteria. His 150 scientific publications include the books The ASAM Criteria and Addiction Treatment Matching. His ASAM CONTINUUM – The ASAM Criteria Decision Engine^® and ASAM’s CO-Triage^® tools are being adopted nationwide.

In 2016, he co-founded DynamiCare Health, a nationally-scalable technology for Contingency Management and predictive analytics, winning awards from Harvard Business School, the Commonwealth of Massachusetts, the Governor of Ohio, and the New York Times. He has consulted to governments in Belgium, China, Iceland, Israel, Norway, Russia and the U.S.

Description:

Among the behavioral approaches to treating substance use disorder, contingency management (CM) is the best-researched, most effective – and yet least utilized. While physiological approaches address withdrawal, craving, and peripheral drivers of addictive behavior and “talk therapies” engage the cortex and consciousness, the target of CM is the fundamental limbic drive center impact of substances of abuse on motivation. CM draws upon principles of operant conditioning, behavioral economics, and gamification. After a half-century of research, clinicians still have numerous concerns: ethics (is it enabling to pay patients money?), resources (where will the money come from?), testing (frequent and visually witnessed drug testing?), & management (who will do the intricate accounting?).

Technology can surmount each of these obstacles. Studies indicate that technology may enhance motivation, e.g., boosting effort in cognitive behavioral therapy, and supporting MAT adherence, and improve treatment attendance and retention. Results across controlled trials indicate a consistent doubling of rates of abstinence with tech-enabled, remote CM, vs. usual care alone. These effects are found in alcohol, opioid, stimulant, and tobacco use disorder.

Data from thousands of patient events with several different technologic tools indicates that these approaches are feasible with many types of: Substance use disorders (from tobacco smoking to opioids); subpopulations (from pregnant women to criminal justice-involved returning citizens to corporate executives); providers (from counselors to case managers to recovery coaches); and settings (from medical centers to recovery homes to national insurance companies). Large datasets (e.g., >90,000 financial transaction events from 1,400 patients) can generate imminent dropout and relapse indicators with good validity (e.g., 70% positive predictive value) that can be used to issue real-time alerts to providers to intervene — even prior to a patient’s return to drug use. Progress in national policy and multiple new funding resources increasingly offer a path to sustainable implementation of motivational incentives in routine care.

Agenda:

9:00 am Welcome, Introductions, Learning Objectives
9:15 am Rationale: Why CM? Why Now? What is It?
9:40 am Evidence: The Challenge & the Promise
10:00 am BREAK – 15 min.
10:15 am CM Best Practices, Limits, Myths & Truths
10:35 am Strategies for Implementation: Technology
11:00 am CM + Tech: Implementation & Response
11:15 am BREAK – 15 min.
11:30 am CM Integrity & Funding
11:50 am Q&A
12:10 pm Implementation Discussion: How Could Your Program Begin CM?
12:30 pm Adjourn

Learning Objectives:

Attendees will be able to:

1. Describe the research foundation for enhancing treatment outcomes in patients with substance use disorders using contingency management.

2. Explain the obstacles that have prevented wide-spread adoption of contingency management in routine care.

3. Analyze the utility of various new technologies that have been proposed and implemented to overcome the obstacles to adoption of contingency management.

3 Credits: NAADAC CU’s are approved

Social Worker CE’s, Allied MH CE’s and Psychologists CE’s pending