A scientific study to design and implement a contingency management (CM) program, and to evaluate its effectiveness in promoting abstinence and treatment adherence among individuals with opioid use disorder, as well as to explore its potential for broader implementation in clinical settings.

Addiction and drug use can have negative consequences on the health, economy, productivity, and social aspects of communities. Addictive disorders are of high prevalence and often associated with other psychiatric and somatic diseases. Severe cases, often complicated by multiple dependencies of substances and advanced stages of the disease can require the involvement of a variety of caregivers, who are requested to sufficiently cooperate and interact to guarantee an optimal outcome of treatment. Tolerance and withdrawal are the two hallmark criteria of physiological addiction, and, arguably, may also be considered as aspects of a more general concept of preoccupation (or as features that contribute to preoccupation). Tolerance refers to the need to engage in the behavior at a relatively greater level than in the past to achieve previous levels of appetitive effects. As tolerance increases, one likely spends more time locating and engaging in an addiction. Thus, tolerance may indicate increasing preoccupation. Withdrawal refers to physiological or acquired discomfort experienced upon abrupt termination of an addictive behavior. If withdrawal symptoms exist, and worsen, one is likely to be spending more and more time recovering from the after-effects of the addiction, and focused in thought and action on how to cope (e.g., by using again). That is, one is more preoccupied with the addiction when one is spending more time locating, engaging, and recovering from that behavior, and this may reflect processes of tolerance and withdrawal. Historically, addiction treatment systems and research have been organized to provide and improve the outcomes of acute episodes of care. The conceptual model has been that an addicted person seeks treatment, completes an assessment, receives treatment, and is discharged, all in a period of weeks or months. This orientation stands at variance with clinical experience and studies conducted over several decades, which confirm that, although some individuals can be successfully treated within an acute care framework, more than half the patients entering publicly funded addiction programs require multiple episodes of treatment over several years to achieve and sustain recovery. The progress of many patients is marked by cycles of recovery, relapse, and repeated treatments, often spanning many years before eventuating in stable recovery, permanent disability, or death.

Contingency management (CM) is a promising intervention for treating drug dependence. CM treatments rearrange the environment to detect drug use readily and to promote participation in activities that are inconsistent with drug use. These treatments encourage participation upon objective evidence of drug abstinence or engagement in non-drug-related activities. Contingency management (CM) is a behavioral intervention where reinforcement is provided when biologically confirmed drug abstinence is demonstrated, typically in the form of a urine test. Unlike some substance use disorders (SUDs) where there are pharmacological treatments available, all empirically supported treatments for stimulant use disorder are behavioral, and contingency management (CM) has the strongest support. CM, or the provision of reinforcement to encourage abstinence from substances or other behaviors, has strong empirical support, established over decades of research, for the treatment of SUDs, including stimulant, nicotine, alcohol, and opioid use disorders. Although CM is efficacious, it is rarely implemented in practice. A primary obstacle is cost.

Inclusion Criteria:

• Be 18 years of age or older
• Have a diagnosis of a substance use disorder (SUD) according to DSM-5 criteria
• Be able to understand and provide informed consent
• Be willing to comply with study procedures, including regular drug screening and attendance tracking
• Must be able to swallow tablets

Exclusion Criteria:

• Have a severe cognitive impairment or active psychosis that interferes with participation
• Currently experiencing a medical condition that would make participation unsafe