Psych News Alert: December 2024

Tuesday, December 3, 2024

Contingency Management App Improved OUD Treatment Outcomes

Augmenting medications for opioid use disorder (MOUD) with smartphone app–based contingency management resulted in improved treatment outcomes in a group of underinsured patients, according to a study issued yesterday in JAMA Network Open.

Traditionally delivered in clinics, contingency management (CM) provides financial incentives for accomplishing treatment goals, typically an opioid-negative finding on urine drug screens, wrote Elise N. Marino, Ph.D., from the University of Texas Health Science Center at San Antonio, and colleagues. “Although many individuals benefit from adding CM to MOUD, a long-standing limitation of this treatment is the requirement to attend multiple in-person appointments per week.”

The researchers used data from 3,759 uninsured or underinsured adults with opioid use disorder who were receiving publicly funded opioid treatment—including MOUD—from physicians’ offices or specialized clinics in Texas from November 2020 through November 2023. Participants were also given the option to receive a smartphone app–delivered CM program for one year. The app provided online individual and group support facilitated by peers; daily goal setting related to both substance use and recovery/self-care; encouragement; progress-tracking; and the ability to earn up to $800 in retail gift cards as an incentive.

In all, 622 participants (16.5%) opted to take part in the app-based CM. The researchers compared treatment outcomes of 300 participants who used the CM app with 300 participants who were similar in terms of age, sex, race, and ethnicity and chose to receive only MOUD.

Participants who chose the CM app reported significantly fewer days of opioid use at the end of treatment (8 days) compared with those who chose to receive MOUD only (12 days). Overall, 62% of the CM app group remained in treatment for the full year, compared with just 39% of the MOUD-only group. App participants were also significantly more likely to stay in treatment longer (290 days), compared with 236 days among MOUD-only participants.

“As a virtual treatment, app-based CM has fewer infrastructure barriers to implementation and should provide opportunities for rapid dissemination to patients,” Marino and colleagues wrote. “[H]owever, less than one-fifth of our entire sample chose to use it. Obtaining, owning, and navigating app-enabled devices may be barriers for some patients, and these apps require consistent use, which may become burdensome or unappealing over time, leading to low use. It is also possible that clinicians themselves may benefit from additional education and training to support adoption.”

For related information, see the Psychiatric News article “Experts Discuss Options for Treating Stimulant Use Disorder.”

(Image: Getty Images/iStock/PeopleImages)

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on X!

Follow Psychiatric News on LinkedIn!

Monday, December 2, 2024

Behavioral Activation Therapy May Improve MH in Older People Who Have Been Abused

Psychotherapy based on the principles of behavioral activation may help reduce depressive symptoms and thoughts of suicide in people who have experienced elder abuse, according to a study published today in the American Journal of Geriatric Psychiatry.

Isabel Rollandi, Ph.D., of the Weill Cornell Institute of Geriatric Psychiatry, and colleagues examined data from 158 participants ages 60 or older who had experienced elder abuse. All participants had depressive symptoms as shown by a score of at least 10 on the nine-item Patient Health Questionnaire (PHQ-9) but did not have significant cognitive impairment. The researchers also collected data on the participants’ demographics, abuse history, and thoughts of suicide (PHQ-9 item 9) at baseline. The most prevalent abuse was emotional/psychological abuse, reported by 78.5% of participants, followed by verbal abuse, reported by 67.1%.

All participants completed 10 weeks of PROTECT therapy either in person or on the phone. PROTECT therapy consists of 45-minute sessions as follows:

One to three sessions that include discussions and psychoeducation about stress and depression, and to formulate the participants’ treatment goals related to the abuse, such as taking steps to promote safety or improving self-care.
Four to eight sessions to develop action plans to increase engagement in specific pleasurable and socially rewarding activities and meet the goals set.
Two sessions to discuss how the participant was faring in accomplishing goals and to work on strategies to maintain gains after completing the therapy.

At the end of treatment, scores on the PHQ-9—which was administered at the start of each session—dropped a mean of 5.58 points among participants who reported thoughts of suicide at baseline and 5.25 points among those without thoughts of suicide at baseline. In addition, the percentage of participants who reported thoughts of suicide decreased from 19% at baseline to 5.7%.

“These findings suggest that a brief intervention for depression delivered in the community can significantly contribute to reducing depressive symptoms in elder abuse victims regardless of depression severity and presence of [thoughts of suicide],” Rollandi and colleagues wrote. “Furthermore, it shows that a depression intervention can reduce suicidal ideation frequency, contributing to decreasing mortality risk in this vulnerable population. These results highlight and reaffirm the imperative to address the mental health needs of elder abuse victims and to deliver effective and scalable psychotherapy treatments that can be integrated in the community.”

For related information, see the Psychiatric News article “Abuse of Older People Increases During Pandemic.”

(Image: Getty Images/iStock/Goodboy Picture Company)