Adapting Contingency Management for Hospitalized Patients with Stimulant Use Disorder

Hospitals struggle to engage patients with stimulant use disorders, and little is known about how to adapt evidence-based behavioral interventions, such as contingency management (CM), for hospital settings. Our study is the first step in informing the design of a hospital CM intervention.

We performed a qualitative study at a quaternary referral academic medical center in Portland, Oregon. We conducted semistructured qualitative interviews with CM experts, hospital staff, and hospitalized patients, eliciting input about hospital CM adaptations, anticipated challenges, and potential opportunities. We performed a reflexive thematic analysis at a semantic level and shared results for respondent validation.

We interviewed 8 CM experts (researchers and clinicians), 5 hospital staff, and 8 patients. Participants felt CM could benefit hospitalized patients by supporting patient substance use disorder and physical health goals, especially by addressing the boredom, sadness, and loneliness of hospitalization. Participants emphasized that in-person interactions could improve patient-staff relationships by using "super positive" experiences to improve rapport. For successful hospital CM, participants emphasized CM core concepts and potential hospital adaptations, including identifying hospital-specific high-yield target behaviors, ensuring staff training, and using CM to support the hospital discharge transition. Participants also encouraged considering novel mobile app interventions, which may offer more flexibility in the hospital, recommending that such interventions include an in-person CM facilitator.

Contingency management has potential to support hospitalized patients and improve patient and staff experience. Our findings can inform CM interventions for hospital systems seeking to expand access to CM and stimulant use disorder treatment.