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35th AM (2025) - Poster Session
Expanding Contingency Management Beyond Veterans A ...
Expanding Contingency Management Beyond Veterans Affairs Substance Use Disorders Clinics A Qualitative Analysis
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Pdf Summary
This qualitative study explores barriers and facilitators to expanding Contingency Management (CM)—a behavioral intervention offering positive incentives to support recovery from substance use disorders (SUD)—beyond Veterans Affairs (VA) SUD clinics into broader medical and specialty care settings at the San Francisco VA (SFVA). Despite 13% of Veterans in VA healthcare having SUDs and CM being implemented in VA SUD clinics since 2011 (serving over 7,700 Veterans), no CM referrals had originated from non-SUD clinics prior to May 2025 at SFVA.<br /><br />The research involved semi-structured interviews with 11 multidisciplinary VA clinicians (physicians, psychologists, nurse practitioners, nurses, and social workers) from medical, specialty, and SUD care roles. Interviews were analyzed using rapid qualitative analysis to identify factors influencing CM referral practices. Themes were categorized into structural factors, provider attitudes, training/resources, patient engagement, and interdisciplinary collaboration.<br /><br />Key barriers included insufficient provider and patient awareness of CM, lack of clear referral pathways outside SUD clinics, understaffing limiting time for CM activities, stigma surrounding SUD care, and patient social determinants of health restricting participation (e.g., abstinence-based housing rules). Providers also reported limited knowledge and training on CM, alongside competing clinical demands reducing prioritization. Patients’ ambivalence and readiness further complicated engagement. Conversely, facilitators encompassed the VA’s integrated system and national infrastructure supporting CM implementation and training, presence of SUD specialists, positive patient enthusiasm for financial incentives, and potential for telehealth and enhanced electronic health record referral systems.<br /><br />The findings highlight the need for low-burden, feasible strategies—such as streamlined referral pathways, telehealth options, and targeted provider education—to broaden CM access across VA care settings. The research team plans to use these insights to design interventions addressing identified barriers, aiming to improve interdisciplinary collaboration and patient outcomes in SUD recovery beyond specialized clinics.
Keywords
Contingency Management
Substance Use Disorders
Veterans Affairs
San Francisco VA
Behavioral Intervention
Referral Barriers
Provider Training
Patient Engagement
Interdisciplinary Collaboration
Telehealth
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