Feasibility and Acceptability of a Pilot Contingency Management Intervention for Stimulant Use Disorder in a Hospital Setting.

Abstract

Contingency management (CM) is effective for stimulant use disorder (STUD) in community settings. This pilot study assessed the feasibility, acceptability, and preliminary effectiveness of a CM intervention for STUD in a Vancouver, Canada hospital that supports patients to complete medical treatment despite ongoing substance use. Medical inpatients with STUD received a CM intervention involving twice-weekly gift card rewards for stimulant-negative urine drug tests and/or achieving SMART health care goals. Feasibility was defined by recruitment, retention, engagement until discharge, and lack of interference with medical care. Acceptability was assessed through weekly and exit surveys; preliminary effectiveness was determined through self-reported stimulant use via Timeline Followback and survey data on substance use and hospital experience. Forty-two participants enrolled; 21 (50%) had severe STUD and 34 (81%) had concurrent opioid use disorder. Thirty-five participants engaged with CM; 33 (79%) participated until discharge, contributing 227 encounters (median 5 per participant, interquartile range 3.5-8). Weekly surveys indicated high acceptability, including improved hospital experience (90%, 86/96 responses) and desire to continue CM postdischarge (97%, 93/96 responses). Twenty (57%) reported decreased stimulant use compared with baseline Timeline Followback. Exit interviews highlighted CM as motivating behavioral change. Staff (n=6) reported improved patient engagement and no negative impact on care delivery. CM for STUD appears feasible and acceptable in hospital settings and may improve patient experience and engagement. Further research is needed to examine the effectiveness of hospital-based CM on patient outcomes during admission and postdischarge.