Transforming Health Systems to Address Addiction

Melissa Weimer, DO, MCR, FASAM
Yale University

ABSTRACT:
The talk will discuss the need to change health systems to address addiction and implementation strategies that promote change.

Contingency Management: Implementation of a Highly Effective Intervention for the Treatment of Stimulant Use Disorder

Beth Rutkowski, MPH
University of California, Los Angeles

Thomas Freese, PhD
University of California, Los Angeles

ABSTRACT:
Recent evidence indicates that methamphetamine and cocaine play a substantial and increasing role in the illicit drug crisis in the US—the 4th wave of the overdose crisis. The behavioral treatment known as contingency management (CM) has more than three decades of robust research supporting its efficacy for individuals with stimulant use disorder (StimUD). Despite overwhelming evidence supporting CM, it has not been widely used in routine treatment outside the VA healthcare system. This situation is changing as states are arranging funding for CM and developing CM programming for individuals with StimUD.

This presentation will begin with a brief overview of how cocaine and methamphetamine use are contributing to the current overdose crisis. Presenters will review CM protocol elements, evidence for CM, current obstacles to widespread implementation of CM, and strategies for addressing barriers. Present implementation strategies and preliminary results form the Recovery Incentive Program: California’s Contingency Management Benefit. This is the first program to implement CM using Medicaid funding through an 1115 Waiver. The Recovery Incentives Program is being systematically implemented using the Science to Service Lab (SSL) implementation approach which features three core components: didactic training, performance feedback, and external facilitation, augmented with a readiness assessment process for sites and an ongoing fidelity monitoring and feedback component. Strategies to track results of urine drug screens, calculate incentive amounts, and deliver incentives to the participants will be discussed. The presentation will describe implementation processes and will present preliminary results after 18 months of operation, demonstrating both the feasibility, replicability, and effectiveness of a large-scale rollout of this treatment.