Feasibility and acceptability of a contingency management program for stimulant use disorder in a pallet shelter community for homeless-experienced veterans

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment Pub Date : 2025-07-31 DOI:10.1016/j.josat.2025.209771

Michael Hsu , Talia Panadero , Nisha Choothakan , Mikayla O. Castellon , Gregory Gee , Edwin Jacobo , Erin P. Finley , James R. McKay , Peter Capone-Newton , Larissa J. Mooney , Sonya Gabrielian

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引用次数: 0

Abstract

Background

Stimulant use disorder (StUD) is a leading cause of overdose and death among homeless-experienced Veterans (HEVs). Contingency management (CM), a behavioral intervention offering rewards for stimulant abstinence, is the most effective psychosocial treatment for StUD. However, CM remains underutilized and understudied in homeless service settings. We piloted CM at a novel transitional pallet shelter community for HEVs and assessed the intervention's feasibility and acceptability.

Methods

We implemented a 12-week, on-site CM program at a pallet shelter community—comprised of locked, private “tiny homes” alongside on-site case management and health services—at the Veterans Affairs Greater Los Angeles. Veterans with a history of StUD were eligible to participate in twice-weekly urine drug screening (UDS), with voucher-based rewards for stimulant-negative results. Mixed methods were used to evaluate CM's feasibility and acceptability, including quantitative measures of attendance and abstinence and qualitative interviews with participating Veterans (n = 10) and staff (n = 6).

Results

Among 26 enrolled Veterans, average session attendance was 32 % and 49 % of UDS samples were negative for stimulants. Qualitative findings identified several factors that supported CM's acceptability, including perceptions that CM was accessible, structured, and supportive; helped meet immediate needs through monetary rewards; and enhanced engagement with health services. Reported barriers included concerns about privacy, stigma, and perceptions of insufficient rewards.

Conclusion

This pilot showed initial Veteran engagement and positive Veteran and staff attitudes toward implementing CM at CTRS, though feasibility and acceptability may be enhanced by addressing concerns regarding privacy, stigma, accessibility, rewards, and integrated psychotherapeutic support.

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在一个有经验的无家可归的退伍军人的托盘庇护社区兴奋剂使用障碍应急管理方案的可行性和可接受性

兴奋剂使用障碍（StUD）是导致无家可归的退伍军人（hev）过量服用和死亡的主要原因。应急管理（CM）是一种行为干预，为戒除兴奋剂提供奖励，是对StUD最有效的心理社会治疗。然而，CM在无家可归者服务环境中仍未得到充分利用和研究。我们在一个新的混合动力汽车过渡性棚户区进行了CM试点，并评估了干预措施的可行性和可接受性。方法我们在大洛杉矶退伍军人事务部的一个棚户区实施了一项为期12周的现场CM项目，该社区由上锁的私人“小房子”组成，同时提供现场病例管理和卫生服务。有StUD病史的退伍军人有资格参加每周两次的尿液药物筛查（UDS），对兴奋剂阴性的结果给予基于代金券的奖励。采用混合方法评估CM的可行性和可接受性，包括定量测量出勤和禁欲，以及对参与的退伍军人（n = 10）和工作人员（n = 6）进行定性访谈。结果在26名退伍军人中，平均出勤率为32%，49%的UDS样本兴奋剂呈阴性。定性的发现确定了支持配置管理可接受性的几个因素，包括认为配置管理是可访问的、结构化的和支持性的；通过金钱奖励帮助满足即时需求；加强与卫生服务机构的接触。报告的障碍包括对隐私、耻辱和奖励不足的担忧。该试点初步显示了退伍军人对在CTRS实施CM的参与和积极的态度，尽管通过解决隐私、污名、可及性、奖励和综合心理治疗支持等问题可以提高可行性和可接受性。

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来源期刊

Journal of substance use and addiction treatment Biological Psychiatry, Neuroscience (General), Psychiatry and Mental Health, Psychology (General)

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