Michigan Innovations in Addiction Care through Research and Education and the Opioid Research Institute are piloting a program aimed at reducing health care inequities by making treatment for substance abuse disorder more accessible. The program, led by Co-Director of MI-ACRE Lara Coughlin and Anne Fernandez, director of clinical research, uses smartphones to incentivize positive behaviors through financial rewards in addiction recovery.
The project is focused on contingency management, a treatment for substance use disorder that incentivizes certain behaviors to support a person’s recovery, which is rooted in behavioral economics and operant conditioning. The pilot program applies a digital form of contingency management, where participants are rewarded for actions that support recovery such as remembering to take medications.
In an interview with The Michigan Daily, Fernandez explained how the program actually functions, with participants earning money through engaging in certain behaviors.
“When they do things that are consistent with recovery, including taking medications for opioid use disorder or abstaining from substances, they actually make money that’s put on a smart debit card,” Fernandez said.
Coughlin and Fernandez plan to recruit people struggling with both alcohol use and opioid use disorder across multiple clinics in the state of Michigan to pilot the program.
“We’re recruiting 50 people who will be randomized to either the control group or to the active condition,” Fernandez said. “We are specifically working with this real-world population through clinics, using a digital platform to try to make the access and use of it easier for people and also seeing if it works in this diagnosis population.”
However, Fernandez acknowledged several challenges to widespread adoption of the treatment method, noting a lack of national or state financial support.
“One of the big challenges is in applying it in real-world settings, partially because there hasn’t always been support for it on a national or state level or programs that will pay for it,” Fernandez said.
To begin overcoming these challenges, Fernandez and Coughlin recently received a $1.17 million grant through the National Institutes of Health’s Helping to End Addiction Long-term Initiative, which will support the continuation of the program.
Through piloting the program, Fernandez emphasized that one of the team’s goals is to increase accessibility for people with fewer resources to be able to receive treatment.
“Some of the work that I’m working with (Coughlin) on are focused on evaluating both the effectiveness of these treatments, but more importantly, how to actually get them to people who need them in the community with different types of addiction,” Fernandez said.
In an interview with The Daily, Humnah Wasi, U-M alum and former research assistant at the University’s Community-engaged Health Optimization for Improved Care and Equity Lab, directed by Coughlin, praised the app’s potential to improve access to care.
“With the access to health care, I definitely could see this make an impact with the use of smartphones because that is something even those who don’t have access to a lot of other resources have,” Wasi said. “The connectability and actually being able to just pull out your phone and have that resource will definitely make an impact in the larger field of psychology.”
In an interview with The Daily, LSA junior Eva Harden, who is involved in psychology research through the Undergraduate Research Opportunity Program, also applauded the accessibility of the app to help treat those that may not have adequate access to health care.
“I feel like it definitely could bring on a lot more effective solutions, just because of the accessibility of it,” Harden said. “Possibly, if they didn’t even have insurance that would help them see a therapist that would help them get off drugs, maybe they could use this app instead, which I think would be something absolutely amazing.”
Harden also said she supported the financial incentivization method of the program because of the dopamine hit people with addictions often struggle with.
“It’s great to incentivize people to stop using drugs with an incentive like money, especially because we know that drugs, why they are so addictive, is because they give people a dopamine hit,” Harden said. “It would be interesting to see if that dopamine hit from getting money outweighs that dopamine hit from using drugs.”
Looking forward, Fernandez said she hopes the program will open doors to a promising future for digital contingency management as a method of treatment for substance use disorder.
“Our hope with this study is that our work — partnering with these clinics, using the digital approach to contingency management and working with the state and payers — will demonstrate that we can implement this digital contingency management program,” Fernandez said. “(We hope to) also create what we refer to as an implementation blueprint or a plan moving forward, where this could actually become supported by payers or by funding of some sort, so that it could go beyond the study and beyond our research budget and actually be implemented to people within the state who need it.”
Daily Staff Reporter Grace Park can be reached at gracepm@umich.edu.
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