Supporting Patients With Stimulant Use Disorder During and After Hospitalization With a Mobile App-based Contingency Management Intervention: A Feasibility and Acceptability Study.

Abstract

Contingency management (CM) is the most effective intervention for stimulant use disorder (StUD) but is underutilized. This study examined the feasibility and acceptability of a novel mobile app-based CM intervention for patients with StUD during and after hospitalization. We recruited hospitalized patients with moderate to severe StUD and an expected hospital length of stay of >2 weeks or a heart failure diagnosis. Patients received gift cards for participating in incentivized activities (counseling, drug testing, and recovery-oriented reflections) through the mobile app. Patients could participate for 2 months (including after hospital discharge), earning up to $330. An in-person nurse supported implementation. We collected intervention engagement data (app usage, rewards earned) and conducted qualitative interviews on participants' experiences. Fifty-six participants (68% male, 70% with unstable housing) completed intake. The average hospital length of stay was 33 days, with 64% admitted for infection. Participants engaged for an average of 33.9 days. Engagement varied widely-those in the top quartile earned $173.31 on average, while those in the bottom quartile earned $6.27 on average. Eighty-nine percent of submitted drug tests were negative for stimulants. Participants felt the "positivity" of CM helped them stay "motivated" and "focused" on recovery instead of being "bored" or stressed in the hospital. Thirty-nine (69.6%) patients continued engaging after hospital discharge. Barriers to engagement included physical limitations, feeling overwhelmed, competing priorities, and technological challenges. A novel hospital-based mobile app CM intervention helped patients with StUD cope with hospitalization and supported recovery goals, although program engagement varied widely.