Feasibility and acceptability of a contingency management program for stimulant use disorder in a pallet shelter community for homeless-experienced veterans.

BACKGROUND

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.