Hsu Michael, Panadero Talia, Choothakan Nisha, Castellon Mikayla O, Gee Gregory, Jacobo Edwin, Finley Erin P, McKay James R, Capone-Newton Peter, Mooney Larissa J, Gabrielian Sonya
Veterans Affairs Greater Los Angeles Health Care, 11301 Wilshire Blvd, Los Angeles, CA 90073, United States of America; David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States of America.
Veterans Affairs Greater Los Angeles Health Care, 11301 Wilshire Blvd, Los Angeles, CA 90073, United States of America.
J Subst Use Addict Treat. 2025 Oct;177:209771. doi: 10.1016/j.josat.2025.209771. Epub 2025 Jul 31.
Stimulant use disorder (StUD) is a leading cause of overdose and death among homeless-experienced Veterans (HEVs). Contingency management (CM), a behavioral intervention offering rewards for stimulant abstinence, is the most effective psychosocial treatment for StUD. However, CM remains underutilized and understudied in homeless service settings. We piloted CM at a novel transitional pallet shelter community for HEVs and assessed the intervention's feasibility and acceptability.
We implemented a 12-week, on-site CM program at a pallet shelter community-comprised of locked, private "tiny homes" alongside on-site case management and health services-at the Veterans Affairs Greater Los Angeles. Veterans with a history of StUD were eligible to participate in twice-weekly urine drug screening (UDS), with voucher-based rewards for stimulant-negative results. Mixed methods were used to evaluate CM's feasibility and acceptability, including quantitative measures of attendance and abstinence and qualitative interviews with participating Veterans (n = 10) and staff (n = 6).
Among 26 enrolled Veterans, average session attendance was 32 % and 49 % of UDS samples were negative for stimulants. Qualitative findings identified several factors that supported CM's acceptability, including perceptions that CM was accessible, structured, and supportive; helped meet immediate needs through monetary rewards; and enhanced engagement with health services. Reported barriers included concerns about privacy, stigma, and perceptions of insufficient rewards.
This pilot showed initial Veteran engagement and positive Veteran and staff attitudes toward implementing CM at CTRS, though feasibility and acceptability may be enhanced by addressing concerns regarding privacy, stigma, accessibility, rewards, and integrated psychotherapeutic support.
兴奋剂使用障碍（StUD）是有过无家可归经历的退伍军人（HEV）过量用药和死亡的主要原因。应急管理（CM）是一种为戒除兴奋剂提供奖励的行为干预措施，是治疗StUD最有效的心理社会疗法。然而，CM在无家可归者服务环境中的利用和研究仍然不足。我们在一个为HEV设立的新型过渡板条箱式避难所社区试点了CM，并评估了该干预措施的可行性和可接受性。
我们在洛杉矶退伍军人事务部的一个板条箱式避难所社区实施了一项为期12周的现场CM项目，该社区由带锁的私人“小房子”以及现场病例管理和医疗服务组成。有StUD病史的退伍军人有资格参加每周两次的尿液药物筛查（UDS），对兴奋剂检测结果呈阴性者给予代金券奖励。采用混合方法评估CM的可行性和可接受性，包括出勤和戒除情况的定量测量，以及对参与项目的退伍军人（n = 10）和工作人员（n = 6）的定性访谈。
在26名登记的退伍军人中，平均课程出勤率为32%，49%的UDS样本兴奋剂检测呈阴性。定性研究结果确定了几个支持CM可接受性的因素，包括认为CM容易获得、有组织且提供支持；通过金钱奖励有助于满足即时需求；以及增强了与医疗服务的互动。报告的障碍包括对隐私、耻辱感以及奖励不足的担忧。
这项试点显示了退伍军人初步的参与度，以及退伍军人和工作人员对在CTRS实施CM的积极态度，不过通过解决对隐私、耻辱感、可及性、奖励以及综合心理治疗支持的担忧，可行性和可接受性可能会得到提高。
