Factors associated with contingency management adoption among opioid treatment providers receiving a comprehensive implementation strategy

ABSTRACT

Background: Contingency management (CM) is an evidence-based behavioral intervention for opioid use disorders (OUDs); however, CM adoption in OUD treatment centers remains low due to barriers at patient, provider, and organizational levels. In a recent trial, OUD treatment providers who received the Science to Service Laboratory (SSL), a multilevel implementation strategy developed by a federally funded addiction training center, had significantly greater odds of CM adoption than providers who received training as usual. This study examined whether CM adoption frequency varied as a function of provider sociodemographic characteristics (i.e., age, race/ethnicity, licensure) and perceived barriers to adoption (i.e., patient-, provider-, organization-level) among providers receiving the SSL in an opioid treatment program. Methods: Thirty-nine providers (67% female, 77% non-Hispanic white, 72% with specialty licensure, M_age = 42 [SD = 11.46]) received the SSL, which consisted of didactic training, performance feedback, specialized training of internal change champions, and external coaching. Providers completed a comprehensive baseline assessment and reported on their adoption of CM biweekly for 52 weeks. Results: Providers reported using CM an average of nine 2-week intervals (SD = 6.35). Hierarchical multiple regression found that providers identifying as younger, non-Hispanic white, and without addiction-related licensure all had higher levels of CM adoption frequency. Higher perceived patient-level barriers predicted lower levels of CM adoption frequency, whereas provider- and organization-level barriers were not significant predictors. Conclusions: The significant effect of age on CM adoption frequency was consistent with prior research on predictors of evidence-based practice adoption, whereas the effect of licensure was counter to prior research. The finding that CM adoption frequency was lower among racially/ethnically diverse providers was not expected and suggests that the SSL may require adaptation to meet the needs of diverse opioid treatment providers. Entities using the SSL may also wish to incorporate a more explicit focus on patient-level barriers.

KEYWORDS:

• Barriers
• contingency management
• implementation
• opioid treatment

Author contributions

Sara Becker was responsible for conceptualizing this paper and the mixed-methods analytic plan, served as an independent qualitative coder, and took the lead on manuscript preparation. Lourah Kelly conceptualized the quantitative analysis plan and wrote the analytic plan and results. Katherine Escobar served as an independent qualitative coder and was responsible for reference management. Augustine Kang served as the qualitative consensus coder and drafted the Methods section. Daniel Squires was PI of the original study, led the development of the SSL implementation strategy, and led original data collection. All co-authors reviewed, edited, and approved the manuscript.

Additional information

Funding

This research 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. Neither of these funding sources had involvement in the study design, data collection, analysis, and interpretation, the writing of this report, or the decision to submit the manuscript for publication.