The peers expanding engagement in stimulant harm reduction with contingency management study: a protocol paper
Abstract Background Contingency management (CM) that is delivered by peer recovery support specialists and incentivizes harm reduction goals among people not seeking treatment for stimulant use has not been tested. The Peers Expanding Engagement in Stimulant Harm Reduction with Contingency Managemen...
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| Format: | Article |
| Language: | English |
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BMC
2025-06-01
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| Series: | Addiction Science & Clinical Practice |
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| Online Access: | https://doi.org/10.1186/s13722-025-00577-8 |
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| author | Alexis Cooke Erin Stack Linda Peng Ryan Cook Bryan Hartzler Gillian Leichtling Christi Hildebran Judith M. Leahy Kelsey Smith Payne Lynn E. Kunkel Kim Hoffman P. Todd Korthuis |
| author_facet | Alexis Cooke Erin Stack Linda Peng Ryan Cook Bryan Hartzler Gillian Leichtling Christi Hildebran Judith M. Leahy Kelsey Smith Payne Lynn E. Kunkel Kim Hoffman P. Todd Korthuis |
| author_sort | Alexis Cooke |
| collection | DOAJ |
| description | Abstract Background Contingency management (CM) that is delivered by peer recovery support specialists and incentivizes harm reduction goals among people not seeking treatment for stimulant use has not been tested. The Peers Expanding Engagement in Stimulant Harm Reduction with Contingency Management (PEER-CM) study compares the effectiveness of two peer-facilitated CM interventions: (1) an experimental approach incentivizing achievement of client-identified harm reduction goals and (2) an enhanced standard of care approach incentivizing peer visit attendance. Methods Applying a hybrid type 1 effectiveness-implementation framework and stepped-wedge design across 14 community-based peer services sites across Oregon, the PEER-CM study trains peers to conduct CM. All sites implement the standard CM approach of incentivizing peer visit attendance. Every 2 months, two sites are randomly assigned to initiate the experimental CM condition of incentives for achieving client-directed harm reduction activities. Peers monitor progress and manage incentives. In the experimental approach, peers facilitate client progress on goal-related activities (selected from a standardized list of goals) to support the primary study outcome of reducing opioid overdoses and stimulant overamping. The intended study enrollment is approximately 80 clients per site (N = 1,120). Peer specialists participate in skills-focused coaching-to-criterion coaching process to document proficient CM delivery skills. This includes a series of group coaching sessions and an individual assessment with a standardized patient, observed and rated according to core dimensions of the Contingency Management Competence Scale. Results The primary study outcome is time until peer-reported fatal or first participant-reported non-fatal overdose or overamp (acute stimulant toxicity). Secondary outcomes include achievement of client-identified harm reduction goals and engagement in substance use disorder treatment. We will also demonstrate the feasibility of our coaching-to-criterion process by documenting peer proficiency in CM skills. Qualitative interviews with peers and their clients will explore the optimal context and implementation strategies for peer-facilitated CM. Conclusion PEER-CM is among the first trials to test the effectiveness of peer-facilitated CM for achieving harm reduction goals and reducing overdose in non-treatment-seeking people who use stimulants. The findings will generate evidence for peer-facilitated delivery of CM and application of CM to client-identified harm reduction goals. Trial Registration: This study is registered at ClinicalTrials.gov (NCT 05700994). |
| format | Article |
| id | doaj-art-d320bb04cfc54cb8bbdbd4e9816ecbca |
| institution | DOAJ |
| issn | 1940-0640 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj-art-d320bb04cfc54cb8bbdbd4e9816ecbca2025-08-20T02:39:47ZengBMCAddiction Science & Clinical Practice1940-06402025-06-0120111110.1186/s13722-025-00577-8The peers expanding engagement in stimulant harm reduction with contingency management study: a protocol paperAlexis Cooke0Erin Stack1Linda Peng2Ryan Cook3Bryan Hartzler4Gillian Leichtling5Christi Hildebran6Judith M. Leahy7Kelsey Smith Payne8Lynn E. Kunkel9Kim Hoffman10P. Todd Korthuis11Comagine HealthComagine HealthDepartment of Medicine, Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health & Science UniversityDepartment of Medicine, Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health & Science UniversityAddictions, Drug & Alcohol Institute, University of WashingtonComagine HealthComagine HealthHealth Systems Division, Oregon Health AuthorityHealth Systems Division, Oregon Health AuthorityDepartment of Medicine, Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health & Science UniversityDepartment of Medicine, Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health & Science UniversityDepartment of Medicine, Division of General Internal Medicine, Section of Addiction Medicine, Oregon Health & Science UniversityAbstract Background Contingency management (CM) that is delivered by peer recovery support specialists and incentivizes harm reduction goals among people not seeking treatment for stimulant use has not been tested. The Peers Expanding Engagement in Stimulant Harm Reduction with Contingency Management (PEER-CM) study compares the effectiveness of two peer-facilitated CM interventions: (1) an experimental approach incentivizing achievement of client-identified harm reduction goals and (2) an enhanced standard of care approach incentivizing peer visit attendance. Methods Applying a hybrid type 1 effectiveness-implementation framework and stepped-wedge design across 14 community-based peer services sites across Oregon, the PEER-CM study trains peers to conduct CM. All sites implement the standard CM approach of incentivizing peer visit attendance. Every 2 months, two sites are randomly assigned to initiate the experimental CM condition of incentives for achieving client-directed harm reduction activities. Peers monitor progress and manage incentives. In the experimental approach, peers facilitate client progress on goal-related activities (selected from a standardized list of goals) to support the primary study outcome of reducing opioid overdoses and stimulant overamping. The intended study enrollment is approximately 80 clients per site (N = 1,120). Peer specialists participate in skills-focused coaching-to-criterion coaching process to document proficient CM delivery skills. This includes a series of group coaching sessions and an individual assessment with a standardized patient, observed and rated according to core dimensions of the Contingency Management Competence Scale. Results The primary study outcome is time until peer-reported fatal or first participant-reported non-fatal overdose or overamp (acute stimulant toxicity). Secondary outcomes include achievement of client-identified harm reduction goals and engagement in substance use disorder treatment. We will also demonstrate the feasibility of our coaching-to-criterion process by documenting peer proficiency in CM skills. Qualitative interviews with peers and their clients will explore the optimal context and implementation strategies for peer-facilitated CM. Conclusion PEER-CM is among the first trials to test the effectiveness of peer-facilitated CM for achieving harm reduction goals and reducing overdose in non-treatment-seeking people who use stimulants. The findings will generate evidence for peer-facilitated delivery of CM and application of CM to client-identified harm reduction goals. Trial Registration: This study is registered at ClinicalTrials.gov (NCT 05700994).https://doi.org/10.1186/s13722-025-00577-8Contingency managementImplementationStimulant usePeer support |
| spellingShingle | Alexis Cooke Erin Stack Linda Peng Ryan Cook Bryan Hartzler Gillian Leichtling Christi Hildebran Judith M. Leahy Kelsey Smith Payne Lynn E. Kunkel Kim Hoffman P. Todd Korthuis The peers expanding engagement in stimulant harm reduction with contingency management study: a protocol paper Addiction Science & Clinical Practice Contingency management Implementation Stimulant use Peer support |
| title | The peers expanding engagement in stimulant harm reduction with contingency management study: a protocol paper |
| title_full | The peers expanding engagement in stimulant harm reduction with contingency management study: a protocol paper |
| title_fullStr | The peers expanding engagement in stimulant harm reduction with contingency management study: a protocol paper |
| title_full_unstemmed | The peers expanding engagement in stimulant harm reduction with contingency management study: a protocol paper |
| title_short | The peers expanding engagement in stimulant harm reduction with contingency management study: a protocol paper |
| title_sort | peers expanding engagement in stimulant harm reduction with contingency management study a protocol paper |
| topic | Contingency management Implementation Stimulant use Peer support |
| url | https://doi.org/10.1186/s13722-025-00577-8 |
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