Feasibility, Engagement, and Usability of a Remote, Smartphone-Based Contingency Management Program as a Treatment Add-On for Patients Who Use Methamphetamine: Single-Arm Pilot Study

JMIR Formative Research · 7 authors, 2 centres

AI SUMMARY

FIDELITY 100%

POPULATIONAdult outpatients who used methamphetamine and were receiving care within a large university health system

INTERVENTIONA 12-week fully remote mobile health contingency management program with smartphone-prompted video-verified saliva tests, weekly guide calls, and self-paced CBT modules

COMPARISONNone (single-arm pilot, no control group)

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This single-arm pilot study evaluated a 12-week fully remote smartphone-based contingency management program for adult outpatients who used methamphetamine within a university health system.

Full summary

929 CHARS

This single-arm pilot study evaluated a 12-week fully remote smartphone-based contingency management (CM) program for adult outpatients who used methamphetamine within a large university health system. Of 37 patients screened, 28 (76%) met eligibility and enrolled, and 54% (15/28) completed the welcome phase required to receive the intervention. Engagement with substance testing, guide calls, and CBT modules was variable, and verified abstinence rates were generally low. Usability ratings were favorable. Among the 11 participants with paired baseline and 12-week data, methamphetamine use disorder criteria decreased from a mean of 8.73 (SD 2.76) at baseline to 7.00 (SD 3.61) at 12 weeks (P=.04; Cohen d=−0.54, 95% CI −1.04 to −0.03), with no significant changes in depression, abstinence self-efficacy, or social support. The findings suggest remote CM is feasible to offer but many participants struggle with onboarding.

PICO

PPOPULATION

Adult outpatients who used methamphetamine and were receiving care within a large university health system

IINTERVENTION

A 12-week fully remote mobile health contingency management program with smartphone-prompted video-verified saliva tests, weekly guide calls, and self-paced CBT modules

OOUTCOME

Feasibility (welcome phase completion), engagement, usability ratings, and supplemental clinical outcomes including methamphetamine use disorder criteria

STUDY TYPE

other

SPECIALTY

psychiatry

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10360016

Feasibility, Engagement, and Usability of a Remote, Smartphone-Based Contingency Management Program as a Treatment Add-On for Patients Who Use Methamphetamine: Single-Arm Pilot Study

JMIR Formative Research

READ THE FULL PAPER

ABSTRACT

Abstract Background In the United States, methamphetamine-related overdoses have tripled from 2015 to 2020 and continue to rise. However, efficacious treatments such as contingency management (CM) are often unavailable in health systems. Objective We conducted a single-arm pilot study to evaluate the feasibility, engagement, and usability of a fully remotely delivered mobile health CM program offered to adult outpatients who used methamphetamine and were receiving health care within a large university health system. Methods Participants were referred by primary care or behavioral health clinicians between September 2021 and July 2022. Eligibility criteria screening was conducted by telephone and included self-reported methamphetamine use on ≥5 out of the past 30 days and a goal of reducing or abstaining from methamphetamine use. Eligible participants who agreed to take part then completed an initial welcome phase that included 2 videoconference calls to register for and learn about the CM program and 2 “practice” saliva-based substance tests prompted by a smartphone app. Participants who completed these welcome phase activities could then receive the remotely delivered CM intervention for 12 consecutive weeks. The intervention included approximately 24 randomly scheduled smartphone alerts requesting a video recording of themselves taking a saliva-based substance test to verify recent methamphetamine abstinence, 12 weekly calls with a CM guide, 35 self-paced cognitive behavioral therapy modules, and multiple surveys. Financial incentives were disbursed via reloadable debit cards. An intervention usability questionnaire was completed at the midpoint. Results Overall, 37 patients completed telephone screenings, with 28 (76%) meeting the eligibility criteria and consenting to participate. Most participants who completed a baseline questionnaire (21/24, 88%) self-reported symptoms consistent with severe methamphetamine use disorder, and most had other co-occurring non-methamphetamine substance use disorders (22/28, 79%) and co-occurring mental health disorders (25/28, 89%) according to existing electronic health records. Overall, 54% (15/28) of participants successfully completed the welcome phase and were able to receive the CM intervention. Among these participants, engagement with substance testing, calls with CM guides, and cognitive behavioral therapy modules varied. Rates of verified methamphetamine abstinence in substance testing were generally low but varied considerably across participants. Participants reported positive opinions about the intervention’s ease of use and satisfaction with the intervention. Conclusions Fully remote CM can be feasibly delivered within health care settings lacking existing CM programs. Although remote delivery may help reduce barriers to treatment access, many patients who use methamphetamine may struggle to engage with initial onboarding. High rates of co-occurring psychiatric conditions in the patient population may also contribute to uptake and engagement challenges. Future efforts could leverage greater human-to-human connection, more streamlined onboarding procedures, larger incentives, longer durations, and the incentivization of non–abstinence-based recovery goals to increase uptake and engagement with fully remote mobile health–based CM. Keywords: contingency management, methamphetamine use disorder, mobile health, mHealth, mobile phone

CITATION EXPORT

Kevin A Hallgren, Mark H Duncan, Matthew D Iles-Shih et al.. Feasibility, Engagement, and Usability of a Remote, Smartphone-Based Contingency Management Program as a Treatment Add-On for Patients Who Use Methamphetamine: Single-Arm Pilot Study. JMIR Formative Research. (2023). https://doi.org/10.2196/47516

AUTHORS

7 · 2 CENTRES

Kevin A Hallgren, Mark H Duncan, Matthew D Iles-Shih, Eliza B Cohn, Connor J McCabe, Yanni M Chang, Andrew J Saxon

1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
2Center of Excellence in Substance Addiction Treatment and Education, Veterans Health Administration Puget Sound Health Care System, Seattle, WA, United States