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

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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.