Integrating Contingency Management into Routine Care for Alcohol Use Disorder Contingency Management (CM) is a well-researched, highly effective methodology for improving alcohol use disorder treatment outcomes by leveraging the power of incentives, but adoption has been limited due to financial, training, and effort burdens on providers. DynamiCare Health is a tech startup formed to overcome the multiple barriers to CM adoption. Using existing tools, DynamiCare aims to build an integrated software/hardware platform to automate CM, eliminating provider burden. It integrates home-based breathalyzer testing (with smart-phone ?selfie? validation), real-time monitoring, immediate patient rewards/feedback, and direct transfer of reward money to a debit card that can block bars and liquor stores. Phase I develops the CM platform, DynamiCare Rewards, which gives patients monetary rewards on the debit card in exchange for self-administered negative breathalyzer and saliva tests. Software development and quality assurance are followed by a pilot study (open label; 12 weeks) in 30 community-based outpatients receiving Treatment As Usual (TAU) to determine acceptability and feasibility of the intervention. Follow-up surveys will be conducted with patients, family members/supporters, and providers, to determine their perception of DynamiCare Rewards, including the willingness of patients to participate in self-administered drug and alcohol testing over extended periods of time in order to earn incentive rewards. In addition to building and testing DynamiCare Rewards, we will explore feasibility of a ?crowdfunding? platform where families can provide the funds for DynamiCare Rewards incentives. This application builds upon the success of: 1) mobile-based CM implementations, which have been scientifically demonstrated to be effective (though never commercialized); and 2) the debit card, which has been used at 40 treatment programs (without CM) with a well-established record of family financial contributions. This is a unique extramural treatment adjunct that has drawn serious interest (and investment) from clinical, policy, payer and commercial leaders. The goal of a successful SBIR effort is to fully develop this scalable technology that has potential for widespread adoption by providers, consumers and payers.
This research will guide the development of a nationally scalable technology platform for adoption into routine clinical use of the highly efficacious Contingency Management (CM) model of alcohol use disorder treatment. CM, a behavioral psychology paradigm addressing brain reward system disruption following chronic use of addictive substances, shows impressive efficacy, but is unused by >90% of US treatment programs due to provider burden and incentive funding logistics. The proposed Phase I study integrates innovative technologies to remove implementation barriers, aiming to spread this evidence-based methodology via a commercial technology platform.
