SBIR-STTR Award

Integrating Contingency Management into Routine Care for Alcohol Use Disorder Contingency Management (CM) is a well-researched, highly effective methodology for improving alcohol use disorder treatment outcomes by leveraging the power of incentives, but adoption has been limited due to financial, training, and effort burdens on providers. DynamiCare Health is a tech startup formed to overcome the multiple barriers to CM adoption. Using existing tools, DynamiCare aims to build an integrated software/hardware platform to automate CM, eliminating provider burden. It integrates home-based breathalyzer testing (with smart-phone “selfie” validation), real-time monitoring, immediate patient rewards/feedback, and direct transfer of reward money to a debit card that can block bars and liquor stores. Phase I develops the CM platform, DynamiCare Rewards, which gives patients monetary rewards on the debit card in exchange for self-administered negative breathalyzer and saliva tests. Software development and quality assurance are followed by a pilot study (open label; 12 weeks) in 30 community-based outpatients receiving Treatment As Usual (TAU) to determine acceptability and feasibility of the intervention. Follow-up surveys will be conducted with patients, family members/supporters, and providers, to determine their perception of DynamiCare Rewards, including the willingness of patients to participate in self-administered drug and alcohol testing over extended periods of time in order to earn incentive rewards. In addition to building and testing DynamiCare Rewards, we will explore feasibility of a “crowdfunding” platform where families can provide the funds for DynamiCare Rewards incentives. This application builds upon the success of: 1) mobile-based CM implementations, which have been scientifically demonstrated to be effective (though never commercialized); and 2) the debit card, which has been used at 40 treatment programs (without CM) with a well-established record of family financial contributions. This is a unique extramural treatment adjunct that has drawn serious interest (and investment) from clinical, policy, payer and commercial leaders. The goal of a successful SBIR effort is to fully develop this scalable technology that has potential for widespread adoption by providers, consumers and payers.

Public Health Relevance Statement:
Project Narrative This research will guide the development of a nationally scalable technology platform for adoption into routine clinical use of the highly efficacious Contingency Management (CM) model of alcohol use disorder treatment. CM, a behavioral psychology paradigm addressing brain reward system disruption following chronic use of addictive substances, shows impressive efficacy, but is unused by >90% of US treatment programs due to provider burden and incentive funding logistics. The proposed Phase I study integrates innovative technologies to remove implementation barriers, aiming to spread this evidence-based methodology via a commercial technology platform.

Project Terms:
addiction; Address; Adopted; Adoption; Alcohol or Other Drugs use; alcohol testing; alcohol use disorder; Alcohols; base; Behavioral; Brain; Breathalyzer Tests; Cellular Phone; Chronic; Clinical; Cods; Communities; Computer software; contingency management; cost; design; Development; Devices; distilled alcoholic beverage; drug testing; Effectiveness; Ethical Issues; evidence base; Evidence based treatment; Extramural Activities; Family; Family member; Feedback; Financial Contribution; financial incentive; follow-up; Friends; Funding; Goals; Health; high risk; Home environment; Hospitalization; improved; improved outcome; Incentives; Individual; innovative technologies; interest; Intervention; Investments; Logistics; Manuals; Methodology; Modeling; Monitor; novel; novel strategies; open label; Outcome; Outpatients; Participant; Patient-Focused Outcomes; Patients; Perception; Pharmaceutical Preparations; Phase; phase 1 study; Pilot Projects; Policies; portability; Preparation; Program Appropriateness; Provider; Psychology; psychosocial; Public Health; quality assurance; Randomized Controlled Trials; Recovery; Research; Rewards; routine care; Saliva; Schedule; Self-Administered; Small Business Innovation Research Grant; software development; Solid; Substance Use Disorder; success; Surveys; System; Technology; Testing; Time; tool; Training; treatment as usual; treatment center; Treatment outcome; treatment program; Validation; Vision; willingness

This application proposes to continue clinical effectiveness and cost-effectiveness testing of the DynamiCare Health platform. This is an innovative smartphone-based digital coaching program that offers remotely-delivered contingency management (CM), Recovery Coaching, and cognitive behavioral therapy (CBT) content to address alcohol use disorder (AUD). CM, which uses financial incentives to reward abstinence and treatment attendance, is one of the most effective, evidence-based, and overlooked intervention for substance use disorders (SUD). DynamiCare, through its remote delivery system, has addressed the logistical barriers to adoption, and now seeks, through this proposal, to drive payer adoption. Our Phase 1 preliminary data shows that the intervention is acceptable and can be highly effective when delivered as a supplemental therapy to persons with AUD enrolled in treatment. Phase 2 proposes to partner with Vermont (VT) Medicaid to deploy and test the fully developed intervention in an RCT among individuals with AUD (n=300). Our goals are to: 1) Deploy the DynamiCare CM and digital coaching program at scale among VT Medicaid members with AUD; 2) determine clinical effectiveness; and 3) evaluate the cost-effectiveness and return-on-investment from the payer perspective. This study design addresses a lack in the CM literature of empirical evidence on the cost-savings for payers from CM. If CM can be shown to create cost-savings for payers, the final barrier to widespread adoption would fall. Overall, this Phase 2 project, which follows a highly successful Phase 1, will provide critical data to advance the utility of this innovative digital platform as it is deployed in the real world to help the millions of people with AUD.

Public Health Relevance Statement:
8. Project Narrative DynamiCare Health has developed a digital coaching program to address alcohol use disorder (AUD), combining Recovery Coaching, cognitive behavioral therapy content, and contingency management (CM), which is one of the most effective yet under-utilized interventions in addiction treatment. This project builds on initial clinical success in Phase 1 to deploy this program at-scale in partnership with a state Medicaid agency, to measure clinical impact and cost effectiveness. If successful, this project will provide the national healthcare system a powerful new multi-modal intervention to decrease the harms and costs associated with AUD.

Project Terms:
Abstinence; addiction; Address; Adopted; Adoption; alcohol abstinence; alcohol and other drug; Alcohol or Other Drugs use; alcohol use disorder; Alcohols; Award; base; behavior change; Businesses; Cellular Phone; Clinical; Clinical Data; Clinical effectiveness; Cods; Cognitive Therapy; contingency management; cost; cost effectiveness; Cost Savings; cost-effectiveness evaluation; Data; design; Diagnosis; digital; effectiveness measure; Effectiveness of Interventions; effectiveness testing; Enrollment; evidence base; Evidence based intervention; falls; financial incentive; Funding; Goals; Health; Health Insurance Portability and Accountability Act; Healthcare Systems; improved outcome; Incentives; Individual; innovation; Insurance Carriers; Intervention; Investments; Literature; Logistics; Manuals; Measures; Medicaid; member; motivated behavior; multi-component intervention; Patient-Focused Outcomes; Persons; Phase; Population; programs; Provider; psychosocial; Randomized Clinical Trials; Randomized Controlled Trials; Recovery; Research Design; response; Rewards; Sampling; Small Business Innovation Research Grant; Solid; Substance Use Disorder; success; System; Technology; telehealth; Testing; Traction; Training; treatment program; Urine; Vermont