Training opioid addiction treatment providers to adopt contingency management: A prospective pilot trial of a comprehensive implementation science approach

ABSTRACT

Background: Few prospective studies have evaluated theory-driven approaches to the implementation of evidence-based opioid treatment. This study compared the effectiveness of an implementation model (Science to Service Laboratory; SSL) to training as usual (TAU) in promoting the adoption of contingency management across a multisite opioid addiction treatment program. We also examined whether the SSL affected putative mediators of contingency management adoption (perceived innovation characteristics and organizational readiness to change). Methods: Sixty treatment providers (39 SSL, 21 TAU) from 15 geographically diverse satellite clinics (7 SSL, 8 TAU) participated in the 12-month study. Both conditions received didactic contingency management training and those in the predetermined experimental region received 9 months of SSL-enhanced training. Contingency management adoption was monitored biweekly, whereas putative mediators were measured at baseline, 3 months, and 12 months. Results: Relative to providers in the TAU region, treatment providers in the SSL region had comparable likelihood of contingency management adoption in the first 20 weeks of the study, and then significantly higher likelihood of adoption (odds ratios = 2.4–13.5) for the remainder of the study. SSL providers also reported higher levels of one perceived innovation characteristic (Observability) and one aspect of organizational readiness to change (Adequacy of Training Resources), although there was no evidence that the SSL affected these putative mediators over time. Conclusions: Results of this study indicate that a fully powered randomized trial of the SSL is warranted. Considerations for a future evaluation are discussed.

Keywords:

• Adoption
• contingency management
• implementation
• opioid

Author contributions

Drs. Becker and Squires contributed equally to this work. Dr. Becker was responsible for conceptualizing this manuscript and taking the lead on its the preparation, whereas Dr. Squires was the Principal Investigator responsible for conceptualizing the original study design, obtaining funding, overseeing study execution, and contributing to the writing of this manuscript. Dr. Strong was responsible for designing and conducting the statistical analyses. Drs. Barnett and Monti were Co-investigators of the original study and contributed to study conceptualization, obtaining funding, and overseeing study execution. Dr. Petry was a Consultant on the original study and was responsible for overseeing the development of the contingency management training protocol and delivery. All co-authors reviewed, edited, and approved this manuscript.

Funding

This work was supported by grants R21DA021150 (Principal Investigator [PI]: D. Squires) and K23DA031743 (PI: S. Becker) from the National Institute on Drug Abuse and grant 5UD1TI013418 (PI: D. Squires) from the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services. The views and opinions contained within this document do not necessarily reflect those of the National Institute on Drug Abuse or the US Department of Health and Human Services, and should not be construed as such.