Contingency Management for Recovery Oriented Activities at Recovery Houses

In this study, the investigators will implement contingency management at rural recovery houses, where individuals with substance use disorders reside. Contingency management is a behavioral intervention in which participants receive incentives (rewards) when they complete planned tasks that are consistent with their recovery efforts. House staff members will also participate in this study and will be trained to provide contingency management to residents. The investigators will compare recovery houses that implement contingency management to matched houses that do not, and the main outcomes will be engagement in the planned activities and retention in the recovery houses. Participants will receive contingency management for up to 12 weeks and follow-up will occur 6 months post-treatment.

A quasi-experimental design will be used. Half of the recovery houses residents will be randomly assigned to receive training in and to conduct contingency management. The other half will receive no additional training or interventions (usual care).

In addition to receiving usual care at the recovery house, participants assigned to this arm will receive contingency management by trained recovery house staff in addition to their usual care. Contingency management sessions will be led by a trained recovery house staff member who is also a research participant in the study. Contingency management will occur once weekly for sessions of approximately 10-15 minute duration for up to 12 weeks. Participants will plan three recovery-oriented activities with the staff member each week, and upon verification of completion of the tasks, the resident participant can earn prize draws of varying monetary amounts.

Participants in this arm will receive usual care that they would normally receive at the recovery houses. Recovery houses are safe, healthy, family-like substance-free living environments that support individuals in recovery from addiction. Although recovery residences vary considerably, this form of housing benefits individuals in recovery by reinforcing a substance-free lifestyle and providing direct connections to other peers in recovery, mutual support groups and recovery support services.

The investigators will implement a prize-based contingency management protocol in which residents will complete three pre-planned recovery-oriented activities each week for a period of up to 12 weeks. Upon verified completion of the activities each week, participants may earn prize incentives through drawing from a prize fishbowl or spinning a virtual prize wheel. Prizes will be money added to a debit card. On the first week and individual has completed pre-planned activities, s/he can receive up to 1 draw per activity completed (3 total), and each week the number of prize draws per activity will escalate by 1. If a participant fails to complete any activities, he/she will not receive the draws for the uncompleted activities, and the prize draws would be reset to 1 in the next week. Participants can earn up to $75 in incentives in total.

Participants in this arm will receive usual care that they would normally receive at the recovery houses. Recovery residences vary considerably, this form of housing benefits individuals in recovery by reinforcing a substance-free lifestyle and providing direct connections to other peers in recovery, mutual support groups and recovery support services.

Treatment Satisfaction Questionnaire (Scores range from 1 to 7 with higher scores reflecting greater satisfaction)

Self-report Quality of Life inventory (scores range from -3 to 3 with higher scores reflecting greater quality of life)

Short Form 36 (SF-36) is a brief measure of overall self-reported health. Scores range from 0 (maximum disability) to 100 (no disability)

A measure of depression symptoms. Scores on the PHQ 9 range from 0 (no depression) to 27 (severe depression).

Urine drug screen of metabolites for cocaine, methamphetamine, barbiturates, opioids, cannabis, alcohol and benzodiazepines

Timeline Follow-back (TLFB) is a self-report, calendar-based measure of the frequency of substance use

Treatment Feasibility will assessed as the proportion of eligible participants who are willing to participate after initial screening.

Inclusion Criteria: Age 18 or older; a resident of the recovery house; and able to provide informed consent. Exclusion Criteria: expected to be discharged from the recovery house in the next two months; experiencing uncontrolled mania, psychosis or suicidality.

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