Using state opioid response grant funding to disseminate contingency management for substance use disorder treatment in Indiana

Introduction: Contingency management (CM) is an efficacious psychosocial intervention for substance use disorders with over 25-years of empirical support, yet CM adoption in SUD treatment settings is limited. In 2020, SAMHSA's State Opioid Response Grant (SOR) initiative included CM as an allowable activity to "treat stimulant use disorder and concurrent substance misuse, and to improve retention in care." This policy-driven funding mechanism has significant potential to expand CM implementation nationally. This study describes an SOR-funded program to disseminate CM in Indiana.

Methods: Indiana government and university partners developed a multi-component, statewide CM dissemination and implementation plan, including 1) statewide promotion, 2) detailed application process for interested SUD treatment agencies, 3) live, expert-led CM workshop, 4) technical assistance (TA) sessions for participating agencies, and 5) agency-level start-up funds to offset CM-related expenses. The study collected data on provider/staff characteristics, CM knowledge and attitudes, readiness, perceived barriers, and CM implementation at pre- and post-training workshop and at 3- and 6-month follow-up. In Year 2, the study collected client-reported quality assurance data.

Results: Staff (N = 72) from 12 selected agencies (13 sites) attended the CM workshop. About half (57 %) had some familiarity with CM, but only 14 % had any prior CM experience or training. Post workshop, participants reported increased CM knowledge and increased confidence in ability to implement CM. Sites completed 3-7 CM TA sessions and developed a tailored CM program. By 6 months, 9 sites had begun CM implementation. These sites averaged 57 days of implementation (range = 25-122), engagement of 23 clients (range = 4-77), delivery of 208 CM reinforcers (gift card codes; range = 8-366), and per-client payouts of $33.77 (range = $11.25-$49.48). Identified barriers to CM implementation included lack of time, client referrals, and resources (administrative, economic). Client-level quality assurance data indicated provider adherence to CM.

Conclusions: A multi-component training model funded by SOR yielded several new CM programs that operated successfully within SAMHSA's guidelines. Organizational barriers related to readiness/capacity, turnover, and buy-in remained for some sites and warrant attention in future CM dissemination and implementation efforts. This work illustrates the promise of applying SAMHSA SOR awards to disseminate CM in community agencies.