Recent evidence indicates that methamphetamine and cocaine play a substantial and increasing role in the illicit drug crisis in the US—the 4th wave of the overdose crisis. The behavioral treatment known as contingency management (CM) has more than three decades of robust research supporting its efficacy for individuals with stimulant use disorder (StUD). Despite overwhelming evidence supporting CM, it has not been widely used in routine treatment outside the VA healthcare system. This situation is changing as states are arranging funding for CM and developing CM programming for individuals with StUD.

This symposium will begin with a brief overview of how cocaine and methamphetamine use are contributing to the current overdose crisis. Presenters will review CM protocol elements, evidence for CM, current obstacles to widespread implementation of CM, and strategies for addressing barriers. They will discuss implementation of CM within the VA healthcare system where it has been used for more than a decade for several indications. In addition, data will be presented on the current status of CM as an adjunct to pharmacotherapy, including medications for opioid use disorder.

The symposium concludes with a review of two large-scale CM implementation projects funded via 1115 Medicaid waivers to allow access to CM as a community-based treatment for StUD in California and Washington. The presentations will describe different clinical applications and implementation strategies in the two states. Preliminary data on the acceptability of CM to staff and patients, along with outcome data (retention and urine drug screen results) will be presented.

• Review the evidence for contingency management for stimulant use disorder and other substance use disorders, including as an adjunct to pharmacotherapy for SUD.
• Identify three barriers to widespread implementation of contingency management, and solutions to address these barriers.
• Identify policy implications from early implementation findings in California, Montana, and Washington that support continued expansion and reimbursement for contingency management.

• Contingency Management
• Stimulant Use Disorder
• Behavioral Treatment
• Clinical Implementation
• Stimulant and Opioid Use Disorders
• Drug Policy

Larissa Mooney, MD, Chairperson, Presenter, Moderator

 

Richardson Rawson, PhD, Presenter, Discussant

 

Richard A. Rawson, Ph.D., is a Research Professor at the Vermont Center for Behavior and Health at the University of Vermont and a Professor Emeritus at the UCLA Department of Psychiatry. He received a Ph.D. in experimental psychology from the University of Vermont in 1974. Dr. Rawson conducted numerous clinical trials on pharmacological and psychosocial/behavioral addiction treatments for the treatment of individuals with cocaine and methamphetamine disorders. He has led addiction research and training projects for the United Nations, the World Health Organization and the U.S. State Department, exporting science-based knowledge to many parts of the world. He is a member of the Motivational Incentives Policy Group, a volunteer group that is working to reduce obstacles to the use of contingency management for treatment of stimulant use disorder. He is currently providing technical assistance to 8 states on the development of treatment services for individuals with stimulant use disorder. He was recently awarded the ASAM Presidential Award for Excellence in Teaching and Leadership in Addiction Medicine and made a Distinguished Fellow by the International Society of Addiction Medicine. Dr. Rawson has published 3 books, 40 book chapters, and over 250 peer-reviewed articles and has conducted approximately a zillion workshops, paper presentations, and training sessions.

Thomas Freese, PhD, Presenter

  

Thomas E. Freese (Ph.D. in Clinical Psychology, California School of Professional Psychology, 1995) is currently Director of the UCLA Integrated Substance Abuse Programs (ISAP), and Adjunct Professor in the Department of Psychiatry. Additionally, he serves as Director of Training and Dissemination for the Division of Addiction Psychiatry in the David Geffen School of Medicine at UCLA, Co-Director of the SAMHSA-funded Pacific Southwest (HHS Region 9) Addictions Technology Transfer Center (PSATTC), and Co-PI of the Training and Dissemination contract with DHCS for the Recovery Incentives Program: California’s Contingency Management Benefit. Previously, Dr. Freese served as ISAP Director of Training for 20 years. Dr. Freese has developed and conducted trainings on addiction-related topics across the US and internationally. 

Sara Parent, Presenter

 

Dr. Sara Parent is an Assistant Professor with the PRISM (Promoting Research Initiative in Substance Use and Mental Health) Collaborative in the Community and Behavioral Health Department of Elson S. Floyd College of Medicine at Washington State University. She managed a multi-site clinical trial examining contingency management (CM) adaptations for people with co-occurring serious mental illness and severe alcohol use disorder through which she personally conducted almost 1000 CM visits. She has led statewide training and technical assistance efforts focused on implementing CM for stimulant use disorders in Washington and Montana, supports CM trainings in partnership with tribal communities, and is a consultant for California’s Recovery Incentives program. She provides monthly CM coaching to over 100 treatment or healthcare service locations throughout the United States and has delivered more than 25 educational or training CM presentations and seminars to healthcare providers and SUD treatment professionals. She has co-developed extensive CM training and implementation resources, including electronic tools for facilitating CM delivery and fidelity. She serves on two SAMHSA-led expert panels focusing on contingency management training and development of a Technical Assistant Publication. Dr. Parent strives to deliver and improve CM TTA using evidence-based practices while codeveloping with partners to be responsive to diverse setting and community needs.