Stimulant Use Disorders
Conditions
Brief summary
The purpose of this study is to develop a culturally adapted contingency management (CM) protocol for Black adults with stimulant use disorder.
Detailed description
This project seeks to develop a culturally adapted Contingency Management (CM) intervention for Black adults with stimulant use disorder (StUD). CM is grounded in behavioral economics and involves the use of tangible positive reinforcements to incentivize verifiable pro-health behaviors. There has been a recent surge in fatal stimulant related drug overdoses in the Black community. Black adults in the United States have been experiencing faster rates of overdose deaths, with a rate of 49.5/100,000 in 2022 (1.4 times the rate among White Americans). A resurgence in stimulant use, contamination of community drug supplies with high potency synthetic opioids (HPSO) and a range of structural and social vulnerabilities are major drivers of this unfortunate trend. CM has been shown to be the most effective intervention for StUD as there are no FDA approved medications for this indication. Emerging evidence shows that Black adults who entered treatment with cocaine-positive urines did not show any gains in treatment retention or other clinical outcomes. This observation of disparate health outcomes has informed the urgency to culturally adapt CM for Black population which is at heightened risk given the opioids/stimulant polysubstance fatal overdose. The objective of this research is to develop components of a culturally adapted CM using theoretically and empirically driven approaches. Specific research aims include: 1) Assessment of the target population's behavioral risks, perceived need for prevention, barriers, preferences for intervention and development of components of CM adaptation; 2) production of iterative drafts of the adapted CM and 3.) Pilot randomized controlled trial to examine the short-term efficacy of the adapted CM with the primary outcomes of percent negative urines and longest duration of abstinence during treatment. Aim 3 consists of PI training to deliver the culturally adapted treatment and the culturally adapted treatment will be piloted with the community that the treatment was adapted for over 12 weeks, twice weekly, with a 4 week lead-in phase. Aims 1 and 2 are Observational aims not requiring registration that will inform Aim 3. The focus of this registration is Aim 3.
Interventions
BEHAVIORALCultually Adapted Contingency Management (CM)
Same protocol as basic CM with adaptations incorporated. The adaption will involve the ADAPT-ITT framework and PEN-3 cultural model.
BEHAVIORALBasic Contingency Management (CM)
An escalating schedule of reinforcement for submitting stimulant-negative urine at each clinic visit over the course of the 12 weeks
Sponsors
Yale University
National Institute on Drug Abuse (NIDA)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Participants are adults with stimulant use disorder who identify as Black/African American.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* participants must self-identify as Black/African American * DSM-5 diagnosis of stimulant use disorder in the past month (30 days)
Exclusion criteria
* individuals who are intoxicated or otherwise unable to provide consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent negative urine samples | Week 12 | Participants will provide urine samples twice weekly. Percent of negative urines provided will be calculated. |
| Mean longest duration of abstinence | Week 12 | The longest duration of abstinence in days will be measured. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean treatment retention | Baseline and Week 12. | Treatment retention in days will be measured. |
| Acceptability of Intervention Measure (AIM) | Week 12 | Treatment Acceptability will be measured using the Acceptability of Intervention Measure (AIM), a 4-item measure of perceived intervention acceptability.Total score 1-5 with higher scores indicating greater acceptability. |
| Feasibility of Intervention Measure (FIM) | Week 12 | Feasibility of intervention measured using Feasibility of Intervention Measure (FIM)- a 4-item instrument to assess perceived intervention feasibility. Total score 1-5 with higher scores indicating greater feasibility. |
| Client Satisfaction Questionnaire (CSQ-8) | Week 12 | An 8-item, self-report measure developed to assess global satisfaction with health and behavioral health services. Each item is rated on a 4-point Likert scale, producing total scores ranging from 8 to 32, with higher scores indicating greater satisfaction. The instrument evaluates perceived quality of care, extent to which services met the client's needs, overall benefit, and willingness to recommend the service |
Countries
United States
Contacts
CONTACTOluwole Jegede, MD, PhD
CONTACTAlexander Alario, PhD
PRINCIPAL_INVESTIGATOROluwole Jegede, MD, PhD
Yale University
Outcome results
None listed