JMIR Publications

ABSTRACT

Background:

In the US, methamphetamine-involved overdoses tripled from 2015-2020 and continue to rise. However, efficacious treatments like contingency management (CM) are often unavailable within health systems.

Objective:

We conducted a single-arm pilot study to evaluate the feasibility, engagement, and usability of a fully remotely-delivered mobile health (mHealth) CM program that was offered to adult outpatients who use methamphetamine and were receiving healthcare within a large university health system.

Methods:

Participants were referred by primary care or behavioral health clinicians between 09/2021 and 07/2022. Eligibility criteria were screened by telephone and included self-reported methamphetamine use on ≥5 of the past 30 days and a goal of reducing or abstaining from methamphetamine use. Eligible participants who agreed to participate then completed an initial “welcome phase” that included two videoconference calls to register for and learn about the CM program and two “practice” saliva-based substance tests that were prompted by the smartphone app. Participants who completed these welcome phase activities could then receive the remotely-delivered CM intervention for 12 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 (CBT) modules, and multiple surveys, including an intervention usability questionnaire completed at the study midpoint. Financial incentives were disbursed via reloadable debit cards for completing these activities.

Results:

37 patients completed telephone screens, with 28 meeting eligibility criteria and consenting to participate. Most participants self-reported symptoms consistent with severe methamphetamine use disorder (88%), and most had other co-occurring non-methamphetamine substance use disorders (79%) and co-occurring mental health disorders (86%) according to existing electronic health records. 15 participants (54%) successfully completed the “welcome phase” and were able to receive the CM intervention. Among those participants, engagement with substance testing, calls with CM guides, and CBT modules varied, although rates of verified methamphetamine abstinence in substance testing were generally low. Participants rated the intervention as easy to use and satisfactory, and reported a mixture of positive and neutral opinions regarding the intervention’s clinical usefulness.

Conclusions:

A fully remote CM program can be feasibly delivered within healthcare settings that lack existing CM programs. While remote delivery may help reduce some barriers to treatment access, a sizeable proportion of patients who use methamphetamine may struggle to engage during initial onboarding stages. 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 duration, and incentivization of non-abstinence-based recovery goals to increase uptake and engagement with fully-remote mHealth-based CM. Clinical Trial: none