A smartphone-smartcard platform for contingency management in an inner-city substance use disorder outpatient program

Abstract

Contingency management (CM) is an efficacious incentive-based intervention for promoting drug abstinence, but treatment providers have not widely adopted it. Smartphone and smart debit card technologies can deliver automated, patient-centered, high-fidelity CM and related services, including cognitive behavioral therapy and appointment reminders. This study evaluated clinical outcomes associated with an integrated smartphone-smartcard platform in an inner-city outpatient clinic. We enrolled adults with opioid use disorder (n = 85) over nine weeks, and they received CM services for four months. We retrospectively compared them to matched controls who received services at the same time, from the same provider at a similar, nearby clinic in the same city. The platform was associated with significantly higher rates of counseling appointment attendance in study months 2 to 4 (9.6%-18.0% increases) and an odds ratio of 4.84 for increased proportion of urine samples consistent with drug abstinence and adherence to prescribed medication, compared to controls at 120 days (P < 0.05). Overwhelmingly, participants reported that they found the platform acceptable. These results suggest that the platform is an effective method for remote delivery of CM services that could overcome key logistical barriers to widespread adoption of CM among treatment providers.

Keywords: Buprenorphine; Cognitive behavioral therapy; Contingency management; Incentives; Ohio; Opioid use disorder.