The University of Michigan is launching a statewide pilot program that will use smartphones in the care of individuals living with substance use disorders by rewarding positive behaviors—like taking medication or engaging in treatment—with money, gift cards and vouchers.

Known as digital contingency management, the first-in-the-state effort is an evidence-based treatment that provides motivational incentives to individuals living with opioid, alcohol and other substance use disorders as they meet treatment goals.

The program addresses health inequities, such as a lack of access to care due to transportation or other issues, by offering easy handheld access to care.

U-M’s program will coincide with the Michigan Department of Health and Human Services’ own incentives pilot program, Recovery Incentives. Training with clinics has begun, and both services are set to launch to patients in January 2025.

U-M faculty members Anne Ferndandez and Lara Coughlin of Michigan Innovations in Addiction Care through Research and Education and the Opioid Research Institute, have received a $1.17 million grant from the National Institutes of Health to launch and evaluate the program, which will initially engage Medicaid beneficiaries in Michigan.

“Approximately 80%-90% of people with substance use disorders do not access formal addiction treatment services,” said Coughlin, assistant professor of psychiatry. “Offering programs like digital contingency management allows us to expand access to care for individuals who may not otherwise receive it.

“A key strength of digital contingency management is that it can increase reach of highly effective addiction care, reducing health inequities, while also providing a treatment that many find to be highly appealing. We believe digital contingency management is a needed next step in Michigan addiction care to ultimately improve addiction-related outcomes, including overdose prevention.”

Nearly 8 million people in the United States live with both opioid use disorder and alcohol use disorder.

The theory behind contingency management is to shift the natural reward pathway of the brain from the reward of substances, such as stimulants and opioids, to nondrug rewards for choosing abstinence. The immediate reward can help tip decision making toward the incentives instead of drugs.

A main component of the program is to reach individuals with no or limited access to more formal addiction treatment care.

“Because digital contingency management is delivered remotely, it can reach anyone with a smartphone, which is increasingly ubiquitous and universally available to Medicaid beneficiaries,” said Fernandez, associate professor of psychiatry and assistant medical director at U-M’s Addiction Treatment Services. “In addition to abstinence promotion, digital contingency management can also incentivize treatment engagement, peer recovery participation and other recovery-oriented activities.”

The program and study that will evaluate it seeks to:

• Identify best practices to engage Medicaid beneficiaries with opioid use disorder and alcohol use disorder in digital contingency management through analysis of Medicaid claims data.
• Convene an advisory board to develop a road map for implementation, sustainability and health equity for digital contingency management.
• Test feasibility and acceptability of digital contingency management for co-occurring opioid use disorder and alcohol use disorder.

The pilot program will also help develop a scaling strategy for a future effectiveness and implementation trial. The researchers will conduct exit interviews with participants in order to identify patient and provider perceptions of factors influencing program adoption.

“This program can address multiple recovery-focused behaviors simultaneously with the goal of improving outcomes for co-occurring opioid and alcohol use disorder. We look forward to conducting this research in Michigan and hope that long-term we can scale the program more widely across the state,” Fernandez said.

Written by Kate Barnes, Office of the Vice President for Research