Recruiting

Behavioral InterventionEncouraging Abstinence Behavior in a Drug Epidemic: Optimizing Dynamic Incentives

Sponsor:

Wake Forest University Health Sciences

Code:

NCT04927143

Conditions

Opioid-use Disorder

Cocaine Use Disorder

Opioid Use

Cocaine Use

Substance Use

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Interventions

App-Based Contingency Management

Sham Control

Study Details

Brief summary:

Combatting the rise of the opioid epidemic is a central challenge of U.S. health care policy. A promising approach for improving welfare and decreasing medical costs of people with substance abuse disorders is offering incentive payments for healthy behaviors. This approach, broadly known as "contingency management" in the medical literature, has repeatedly shown to be effective in treating substance abuse. However, the use of incentives by treatment facilities remains extremely low. Furthermore, it is not well understood how to design optimal incentives to treat opioid abuse. This project will conduct a randomized evaluation of two types of dynamically adjusting incentive schedules for people with opioid use disorders or cocaine use disorders: "escalating" schedules where incentive amounts increase with success to increase incentive power, and "de-escalating" schedules where incentive amounts decrease with success to improve incentive targeting. Both schemes are implemented with a novel "turnkey" mobile application, making them uniquely low-cost, low-hassle, and scalable. Effects will be measured on abstinence outcomes, including longest duration of abstinence and the percentage of negative drug tests. In combination with survey data, variation from the experiment will shed light on the barriers to abstinence more broadly and inform the understanding of optimal incentive design.

Conditions

Opioid-use Disorder

Cocaine Use Disorder

Opioid Use

Cocaine Use

Substance Use

Study ID

NCT04927143

Start date

Sep 15, 2021

Status verified date

Feb, 2026

Completion date

Sep, 2026

Anticipated

Primary completion date

Sep, 2026

Anticipated

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Inclusion Criteria:

Age at least 18 years old;
Meet DSM-5 OUD, CoUD, or MUD criteria as evidenced by an OUD CPT code F11\* (opioid related disorders), a CoUD CPT code F14\* (cocaine related disorders), a MUD CPT code F15.1/F15.2 or other clinical notes indicating illicit opioid/cocaine/methamphetamine use for treatment
Have access to a smartphone (iOS or Android) with data plan and willing to download DynamiCare app;
Have an email and can access it from their smartphone;
Are in residential, day (PHP), partial day (IOP), or outpatient (OP) AODA treatment;
Are likely to be helped by contingency management because at least ONE of the following conditions is true:

1. Were first enrolled in residential, PHP, or IOP substance use treatment no longer than 2 treatment weeks (14 days/encounters of treatment) prior to providing informed consent.
2. Used non-medical opioids, cocaine, and/or methamphetamine within the last 21 days.

Understands English.

Exclusion Criteria:

Have evidence of active (non-substance related) psychosis that might impair participation as determined by the PI.
Has significant cognitive impairment that might confound participation as determined by the PI or are so significantly cognitively impaired that they have a legal guardian.

Study Design

Enrollment

600 participants

Anticipated

Allocation

Randomized

Intervention Model

Parallel Assignment

Primary purpose

Supportive Care

Interventions and Outcome Measures

Arms

active comparator: Control

Participants in this group will have access to the DynamiCare app; however, no behavioral incentives will be provided to this group.

experimental: Escalating Low

Participants will have access to the DynamiCare app. Through the app, participants will receive incentive amounts for drug negative saliva tests. Incentive amounts increase with every negative drug test up to a ceiling and "reset" to the lowest amount when a test is positive or missed. The "Low" group will receive incentives worth $2-$8.

experimental: Escalating High

experimental: De-Escalating Low

Participants will have access to the DynamiCare app. Through the app, participants will receive incentive amounts for drug negative saliva tests. Incentive amounts increase with every positive drug tests (up to a ceiling), and decrease by the same increment with every negative drug test (down to a floor). The "Low" group will receive incentives worth $6-12.

experimental: De-Escalating High

Participants will have access to the DynamiCare app. Through the app, participants will receive incentive amounts for drug negative saliva tests. Incentive amounts increase with every positive drug tests (up to a ceiling), and decrease by the same increment with every negative drug test (down to a floor). The "High" group will receive incentives worth $10-$20.

experimental: Constant High

In the Constant groups, incentive amounts will remain unchanged across time. The "High" group will receive incentives worth $16.

experimental: Constant Low

In the Constant groups, incentive amounts will remain unchanged across time. The "Low" group will receive incentives worth $8 every test.

Interventions

App-Based Contingency Management

Participants will receive financial incentives for submitting randomly generated drug-negative saliva tests across the intervention period.

Sham Control

Participants get access to the DynamiCare app but will not be provided with financial incentives.

Primary outcome measure

Percent of Negative Saliva Tests [ Time Frame: month 3 ]
Percent of App Acceptability [ Time Frame: month 12 ]

Central Contacts and Locations

Central contacts

Kevin Petranu

414-293-9736 kevin.petranu@aah.org

Mercedes Robaina, PhD

813-352-9229 mercedes.robaina@aah.org

Locations

Rogers Behavioral Health

Recruiting

Oconomowoc, Wisconsin, United States, 53066

Advocate Aurora Behavioral Health Services

Recruiting

Wauwatosa, Wisconsin, United States, 53212

Contacts

Mercedes Robaina, PhD

800-323-8622 Mercedes.Robaina@aah.org

More Information

Sponsor

Wake Forest University Health Sciences

Last update posted

Feb 12, 2026

Last verified

Feb, 2026

Keywords

contingency management
app-based treatment

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-08. This information was provided to ClinicalTrials.gov by Wake Forest University Health Sciences on 2026-02-12.