# Implementing contingency management in opioid treatment centers across New England: A hybrid type 3 trial

> **NIH NIH R01** · BROWN UNIVERSITY · 2021 · $692,816

## Abstract

Project Description
Overdoses and deaths due to opioid use disorders (OUDs) have been declared a public health emergency in
the United States, bringing to light an urgent need for highly effective OUD treatments. There are currently five
FDA-approved medication formulations, which relative to placebo have demonstrated effectiveness in helping
patients attain abstinence from opioids. Nonetheless, patients' opioid abstinence rates are sub-optimal: even
when treated with the newest extended-release formulations only about 40% of patients maintain abstinence
during the first 6-months of treatment. Contingency management (CM; i.e., motivational incentives for
achieving pre-defined treatment goals) is one of the only behavioral interventions shown to improve patient
abstinence from opioids when combined with FDA-approved pharmacotherapy. Unfortunately, however,
uptake of CM in OUD treatment centers remains low. In response to the urgent need for evidence-based
behavioral OUD treatments, we propose a large-scale type 3 hybrid trial comparing two comprehensive
strategies to promote CM implementation as an adjunct to pharmacotherapy within OUD centers. The control
condition is the staff training strategy used by the SAMHSA-funded network of Addiction Technology Transfer
Centers (ATTC; i.e., didactic workshop + performance feedback + staff coaching). The experimental condition
is the ATTC strategy enhanced by external leadership coaching (ELC; i.e., leadership coaching focused on
sustainment planning) and pay-for-performance (P4P; i.e., monetary bonuses for achieving pre-defined
implementation goals), which we refer to hereafter as E-ATTC. Elements of E-ATTC were informed by our
team's prior NIH-funded work evaluating organization-level implementation strategies. Using a cluster
randomized design, 30 OUD treatment centers across New England will be randomized to one of the two
implementation conditions (ATTC vs. E-ATTC) over the 5 year project. At each OUD treatment center, data will
be collected at multiple intervals from two CM staff (n=60), two organizational leaders (n=60), and 25 newly
admitted patients (n=750). Additionally, 25 patient charts per center (n=750) will be randomly selected for
review to examine sustainment. Data collection will use rigorous, replicable procedures including electronic
medical record review, ratings of audio recordings by staff blind to condition, well-validated measures, and
biological verification of abstinence. Specific Aims of the study are to experimentally compare the effect of the
two conditions on implementation outcomes (Primary Aim) and on patient outcomes (Secondary Aim). An
Exploratory Aim is to test whether two organization-level variables (i.e., implementation climate, leadership
engagement) partially mediate the relationship between implementation condition and the key study outcomes.
Achievement of the Study Aims will address critical public health needs by (a) informing how evidence-based
practice is impl...

## Key facts

- **NIH application ID:** 10215461
- **Project number:** 5R01DA046941-04
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Sara Becker
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $692,816
- **Award type:** 5
- **Project period:** 2018-09-15 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10215461

## Citation

> US National Institutes of Health, RePORTER application 10215461, Implementing contingency management in opioid treatment centers across New England: A hybrid type 3 trial (5R01DA046941-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10215461. Licensed CC0.

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