Dr Carol-Ann Getty is a Research Fellow at the National Addiction Centre, King’s College London. Her research focuses on developing and evaluating behavioural interventions for substance use disorders, with particular expertise in contingency management and its digital delivery. She has led research exploring digital contingency management, its implementation within UK drug and alcohol treatment services, and the perspectives of patients and addiction specialists. Her current work includes the CM4OUD project, funded through a Society for the Study of Addiction academic fellowship, evaluating app-based contingency management to promote heroin abstinence among people receiving opioid treatment, with a focus on improving treatment and outcomes.

Abstract

App-based contingency management for heroin abstinence: feasibility, engagement and learnings from the CM4OUD trial

Aims: Contingency management is effective in reducing illicit substance use, but implementation within UK drug treatment services remains limited. A smartphone app was developed to enable remote monitoring of heroin use and delivery of financial incentives for abstinence. CM4OUD assessed the feasibility and acceptability of conducting a future randomised controlled trial of app-based contingency management to promote heroin abstinence among people receiving opioid agonist treatment.

Methods: Participants receiving opioid agonist treatment and continuing to use heroin were randomised 1:1 to 12 weeks of app-based contingency management plus treatment as usual or treatment as usual alone. The app prompted thrice-weekly remote saliva tests and delivered escalating financial incentives for heroin-negative results. Following low initial engagement, the intervention was modified to include a four-week engagement phase rewarding test submission, followed by an eight-week abstinence-contingent phase.

Results: Forty participants were recruited within 4.5 months; 53/78 (68%) screened were eligible and 40/53 (77%) consented and enrolled. Initial app engagement was 6%, increasing to 54% during the engagement phase and remaining at 45% during the subsequent abstinence phase. Of 236 oral-fluid tests submitted, 225 (95%) were of sufficient quality. Twelve-week follow-up was 63%, identifying retention and timely outcome collection as challenges.

Conclusions: App-based contingency management for heroin abstinence appears feasible, with successful recruitment. However, initial engagement was low, suggesting that technology engagement may need to precede abstinence-contingent reinforcement. Introducing an initial engagement phase substantially increased app interaction. Findings support progression to a definitive trial, with modifications to strengthen early engagement, participant retention and timely biological outcome collection.