Journal of substance use and addiction treatment · 2026
Contingency management for adherence to injectable medication for substance use disorders.
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Gorman Jay A, Ameral Victoria E, Abrams Brent E, Park Dongchan, Kaubrys Madeleine M, Khazanov Gabriela K
Аннотация
INTRODUCTION: Contingency Management (CM) is effective in changing health behaviors but is not widely used across healthcare settings despite evidence supporting its benefits for patient outcomes. Adherence to injectable medication for opioid and alcohol use disorders is a known challenge for this otherwise low-burden treatment option and presents a key opportunity to leverage the benefits of CM for adhering to treatment.
METHODS: This retrospective cohort study sought to compare adherence to injectable medications (i.e., XR-naltrexone and XR-buprenorphine) among veterans who received CM for adherence (n = 42) compared to a cohort of veterans who received injectable medication treatment prior to CM implementation (n = 42).
RESULTS: The CM cohort received 1.62 times more medication doses than the comparison group. Only CM participants had the opportunity to receive XR-buprenorphine because it was not available during the earlier comparison period; however, ANCOVA analyses accounting for medication type, primary diagnosis, and prior injection medication history demonstrated that differences in doses received between cohorts remained robust. The adjusted mean total doses received in the CM cohort (M = 8.59; SE = 0.63) were significantly higher than the comparison cohort (M = 5.36; SE = 0.86; p < .001).
DISCUSSION: CM approaches are a key strategy for improving adherence to life-saving medications for substance use disorders. In this retrospective cohort study, CM implementation was associated with significantly higher rates of medication adherence compared to a cohort who received treatment prior to CM being available. The CM adaptations implemented by the clinic for this naturalistic study may hold promise for future efforts to reduce administrative burdens of CM without sacrificing effectiveness.
METHODS: This retrospective cohort study sought to compare adherence to injectable medications (i.e., XR-naltrexone and XR-buprenorphine) among veterans who received CM for adherence (n = 42) compared to a cohort of veterans who received injectable medication treatment prior to CM implementation (n = 42).
RESULTS: The CM cohort received 1.62 times more medication doses than the comparison group. Only CM participants had the opportunity to receive XR-buprenorphine because it was not available during the earlier comparison period; however, ANCOVA analyses accounting for medication type, primary diagnosis, and prior injection medication history demonstrated that differences in doses received between cohorts remained robust. The adjusted mean total doses received in the CM cohort (M = 8.59; SE = 0.63) were significantly higher than the comparison cohort (M = 5.36; SE = 0.86; p < .001).
DISCUSSION: CM approaches are a key strategy for improving adherence to life-saving medications for substance use disorders. In this retrospective cohort study, CM implementation was associated with significantly higher rates of medication adherence compared to a cohort who received treatment prior to CM being available. The CM adaptations implemented by the clinic for this naturalistic study may hold promise for future efforts to reduce administrative burdens of CM without sacrificing effectiveness.