This program report describes contingency management at Project CARA, a perinatal substance exposure clinic in western North Carolina. Unlike many incentive programs focused on drug-screen results, this initiative rewarded appointment attendance. More than 160 distinct patients participated over 14 months, and preliminary observations suggested attendance was maintained or improved during COVID-19 disruptions. The authors note that a formal quantitative evaluation was still planned, so the report does not establish treatment efficacy.
Abstract
Although the overall rate of substance use disorders in the United States has remained stable since 2016, rates of opioid use and stimulant use have continued to increase. Unlike medications for opioid use disorder, there is currently no pharmacological treatment option for stimulant use disorder. Contingency management (CM), a behavioral health intervention based on operant conditioning, is among the few efficacious treatment options for stimulant use. Project CARA, a perinatal substance exposure clinic in western North Carolina, implemented a CM program in 2020. Project CARA’s CM program targets appointment attendance, unlike many CM programs that target expected urine drug screen results. Over 14 months, Project CARA’s CM program has served more than 160 unduplicated patients. Preliminary data show promise that this program has been effective in maintaining, if not improving, patient appointment attendance despite the challenges of the COVID-19 pandemic and an increase in stimulant use disorders. The authors plan to conduct future research to evaluate the quantitative efficacy of Project CARA’s CM program.
