SMART Trial Efficacy Study

Pilot Test of Contingency Management and Brief Motivational Interviewing + Substance Free Activity Session Interventions + Mindfulness-Based Adherence Promotion

The purpose of this study is to evaluate the efficacy of two different interventions for medication-assisted treatment (MAT) adherence: Contingency Management (CM) and Brief Motivational Intervention plus Substance Free Activities Session plus Mindfulness-Based Adherence Promotion (BMI+SFAS+MBAP). If the interventions are efficacious, they will be used in a larger trial with a SMART (Sequential Multiple Assignment Randomized Trial) design.

We will engage with referred OUD patients at the time of their initial visit to the CAS. Interested patients will be informed about the study in a private room, and if eligible, will be consented and randomized to condition. Randomization will occur in blocks of 4. At the next physician visit, participants will engage in their first treatment activities (either payment of $25 for buprenorphine positive/illicit opioid negative saliva screen for those in CM, or their first BMI+SFAS with an Interventionist). This will be repeated for the following 3 weeks. CM. Those randomized to the CM intervention will receive $25 gift certificates to Amazon for each of the illicit opioid-negative, buprenorphine-positive saliva screens obtained at physician visits. During the pilot trial, 4 clean saliva screens (one each week) will result in a $100 bonus. BMI+SFAS. Those randomized to the BMI+SFAS will engage in a weekly discussion of several areas known to reduce delay discounting and improve decision-making. Topic areas include: Short and Long-Term Goals: identifying goals (e.g., What are your goals for this month…for the next 5 years? What would you like to have accomplished?), requirements needed to achieve these goals (e.g., What would you need to do to achieve those goals?) and the potential role of illicit opioid use in jeopardizing these goals; Reward Bundling: aggregate global day-to-day choices and activities into cumulative, cohesive patterns that relate to personally relevant long-term health or social outcomes.86,87 A behavior with immediate but low reward value (i.e., taking a daily dose of buprenorphine-naloxone) in the short-term may have higher reward value when it is framed as part of a pattern of achieving a valued long-term outcome (i.e., steady employment at a desired job); Episodic Future Thinking88,89: An experiential intervention that prompts individuals to describe personal, emotional, and situational details of a valued future outcome in great detail (e.g., what it would be like to regain family trust or get a career-job); Substance Free Activities: Participants will be offered a menu of substance free activities that has been developed in pilot work. Activities will be discussed, and participants will be asked to engage in selected activities as homework. Engagement in substance free activities will be assessed at each subsequent visit. This weekly intervention will take 30 minutes.

opioid use disorder, OUD, buprenorphine, treatment adherence, substance-free activities, brief motivational interviewing, contingency management

Participants will receive physical rewards urine toxicology results are positive for buprenorphine (i.e., they are adherent to Medication-Assisted Treatment (MAT)) during their first four visits after initiation of MAT.

BSM (Brief Motivational Intervention + Substance Free Activities Session + Mindfulness-Based Adherence Promotion) participants will have one-on-one behavioral intervention sessions at each of the first four visits after initiation of MAT.

Participants will be able to draw a gift card from a fishbowl when their urine toxicology results are positive for buprenorphine (i.e., they are adherent to Medication-Assisted Treatment). Gift cards in the bowl for drawing will be $25, $50, or $100.

Brief Motivational Intervention + Substance Free Activities Session + Mindfulness-Based Adherence Promotion (BSM)

Participants will have one-on-one sessions with a behavioral interventionist to discuss their goals regarding treatment, how to reach these goals, and the importance of substance-free activities.

Inclusion Criteria: Present for an intake appointment at study site for treatment of opioid use disorder. Eligible for receipt of buprenorphine-naloxone treatment (e.g. Suboxone, Bunavil, Zubsolv) as determined by clinic physicians 18 years or older Access to a telephone Ability to comprehend consent and intervention materials (approximately 8th-grade level). Exclusion Criteria: Physician expects that patient will not follow standard treatment visit schedule