Veterans Affairs Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), Pittsburgh, Pennsylvania.
University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania.
J Stud Alcohol Drugs. 2024 Jan;85(1):26-31. doi: 10.15288/jsad.23-00016. Epub 2023 Oct 3.
Contingency management (CM) is the gold standard treatment for stimulant use disorder but typically requires twice- to thrice-weekly in-person treatment visits to objectively verify abstinence and deliver therapeutic incentives. There has been growing interest in telehealth-based delivery of CM to support broad access to this essential intervention--a need that has been emphatically underscored by the COVID-19 pandemic. Herein, we present observations from initial efforts to develop and test a protocol for telehealth-based delivery of prize-based CM treatment incentivizing stimulant abstinence.
Four participants engaged in hybrid courses of CM, including one or more telehealth-based treatment sessions, involving self-administered oral fluid testing to confirm abstinence. Observations from initial participants informed iterative improvements to telehealth procedures, and a 12-week course of telehealth-based CM was subsequently offered to two additional participants to further evaluate preliminary feasibility and acceptability.
In most cases, participants were able to successfully join telehealth treatment sessions, self-administer oral fluid testing, and share oral fluid test results to verify stimulant abstinence. However, further improvements in telehealth-based toxicology testing may be necessary to interpret test results accurately and reliably, especially when colorimetric immunoassay results reflect substance concentrations near the cutoff for point-of-care testing devices.
Preliminary findings suggest that telehealth-based CM is sufficiently feasible and acceptable to support future development, in particular through improved methods for remote interpretation and verification of test results. This is especially important in CM, wherein accurate and reliable detection of both early and sustained abstinence is crucial for appropriate delivery of therapeutic incentives.
（ contingency management，CM）是治疗兴奋剂使用障碍的金标准，但通常需要每周进行两次到三次面对面的治疗，以客观地验证戒断情况并提供治疗激励。人们对基于远程医疗的 CM 治疗越来越感兴趣，以支持广泛获得这种必要的干预措施——这一需求在 COVID-19 大流行期间得到了强烈强调。在此，我们介绍了为基于远程医疗的基于奖励的 CM 治疗开发和测试方案的初步努力的观察结果，该方案旨在鼓励兴奋剂戒断。
四名参与者接受了混合的 CM 课程，包括一次或多次基于远程医疗的治疗，涉及自我管理的口腔液测试以确认戒断。最初参与者的观察结果为远程医疗程序的迭代改进提供了信息，随后向另外两名参与者提供了为期 12 周的基于远程医疗的 CM 课程，以进一步评估初步可行性和可接受性。
在大多数情况下，参与者能够成功加入远程医疗治疗课程、自我管理口腔液测试并共享口腔液测试结果以验证兴奋剂戒断情况。然而，可能需要进一步改进基于远程医疗的毒理学测试，以准确可靠地解释测试结果，尤其是当比色免疫测定结果反映出接近即时检测设备检测限的物质浓度时。
初步发现表明，基于远程医疗的 CM 具有足够的可行性和可接受性，可以支持未来的发展，特别是通过改进远程解释和验证测试结果的方法。这在 CM 中尤为重要，因为准确可靠地检测早期和持续的戒断情况对于正确提供治疗激励至关重要。
