Cultural Adaptation of Contingency Management for adults with Stimulant Use Disorder

About This Grant

This project seeks to develop a culturally adapted Contingency Management (CM) intervention for adults with stimulant use disorder (StUD) in the New Haven community. CM is grounded in behavioral economics, involving the use of tangible positive reinforcements to incentivize verifiable pro-health behaviors. There has been a persistent increase in fatal drug overdoses in New Haven despite four years of consistent reduction in other Connecticut counties. A resurgence in stimulant use, contamination of community drug supplies with high potency synthetic opioids (HPSO) and a range of structural and social issues have been noted as major drivers of this mortality trend. CM has been shown to be the most effective intervention for StUD as there are no FDA approved medications for this indication. Further, emerging evidence shows that 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 informs the urgency to culturally adapt CM for New Haven, a city with culturally rich population, but with heightened risk of overdose given the prevalence of opioids/stimulant polysubstance co-use. The objective of this research is to develop components of a culturally adapted CM for New Haven 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 RCT 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. Completing this K23 proposal will provide the PI with critical new training in several key areas to achieve his long-term career goal of becoming an independent investigator capable of developing, testing, and implementing effective, accessible, and culturally informed substance use interventions for adults in community. Dr. Jegede and his mentors have compiled a comprehensive training plan in the following areas: conducting community-engaged and community based participatory research; developing mastery in culturally salient interventions for StUD, obtaining knowledge and skills in Dissemination Implementation Science methods; and developing skills in conducting randomized controlled trials, responsible conduct of research, and grant writing. This proposal addresses a vexing public health problem of escalating drug related mortality in New Haven by developing a robust and culturally informed adaptation of CM to treat StUD. The vital support from this K23 award will allow Dr. Jegede’s scientific development as he develops into an independent investigator and develop a highly integrated community-engaged research program addressing stimulant use and improving wellbeing among adults in the New Haven community.