Intermediate
Focus Session
David Gastfriend, MD, DFASAM
Chief Architect, CONTINUUM - The ASAM Criteria Decision Engine
ASAM
Paul Earley, MD, DFASAM
Medical Director
Georgia Professionals Health Program
Contingency Management (CM) is the best-researched, most effective -- yet least utilized -- treatment innovation in addiction. After a half-century of research, clinicians still have numerous concerns: ethics (is it enabling to pay patients money?), resources (where will the money come from?), testing (frequent and visually witnessed drug testing?) & management (who will do the intricate accounting?). Technology can surmount each of these obstacles, with the added plus of patient engagement & relapse/dropout prediction. Providers will describe technology's potential for enhancing motivation, improving MAT adherence, & extending treatment retention. Data from thousands of patient events with several different technologic tools indicates that these approaches are feasible with many types of: Substance use disorders (from tobacco smoking to opioids) Subpopulations (from pregnant women to criminal justice-involved returning citizens to corporate executives) Providers (from counselors to case managers to recovery coaches), and Settings (from medical centers to recovery homes to national insurance companies). Finally, large data (e.g., <90,000 financial transaction events from 1,400 patients) can generate imminent dropout and relapse indicators with good validity (e.g., 70% positive predictive value) that can be used to issue real-time alerts to providers to intervene -- even prior to a patient's return to drug use, allowing rapid treatment intensification without the need for repeat detoxification to address withdrawal. Impacts range from decreased drinking, to longer treatment retention to meaningful program completion (e.g., improving graduation rates from 67% to 87% within a justice-system involved long-term rehabilitation). Attendees will workshop how to achieve practical implementation within busy, oversubscribed and scarcely-resourced practices and treatment programs in the midst of an epidemic.