Background

Overdoses involving stimulants more than tripled in the past decade among homeless-experienced Veterans (HEVs). Furthermore, stimulant use disorder (StUD) impedes HEV community integration due to its association with increased drop-out from medical treatment, worsened mental health outcomes, housing instability, incarceration, cardiovascular disease, and premature death. Contingency Management (CM), a behavioral intervention consisting of immediate, tangible rewards to reinforce positive behaviors, is the most effective treatment for StUD. However, despite Department of Veteran Affairs’ (VA) national rollout of CM in 2011, less than 2% of Veterans with StUD have engaged in CM based on a recent evaluative study, with figures likely lower for HEVs. HEVs face unique challenges with engaging in CM such as transportation barriers, low engagement with abstinence-only initiatives, and increased use of high-potency stimulants like methamphetamines. No known studies in the past ten years (since the rapid rise of methamphetamine use) have adapted and evaluated CM for StUD for adults in homeless service settings, within or outside VA. Further studies are needed to understand facilitators and barriers to implementing CM for StUD in homeless care settings.

Methods

We piloted a 12-week Contingency Management for StUD program at the West Los Angeles VA Medical Center Care Treatment and Rehabilitation Service (CTRS), a novel emergency pallet shelter healthcare program for HEVs. We used a modified VA CM protocol that included additional incentives to enhance engagement and adjunctive group Cognitive Behavioral Therapy for Substance Use Disorders. Intervention adaptations were tracked using the Model for Adaptation Design and Impact. We assess feasibility and acceptability of the intervention by conducting ten 45-minute semi-structured interviews with Veteran participants and a 60-minute focus group with CM staff. We analyze interviews using use rapid qualitative analysis methods.

Findings

Engagement and qualitative data will be collected between July and September 2024. We will present our feasibility and acceptability data including program engagement statistics and qualitative findings.

Implications for D&I Research

CTRS presents a unique homeless care setting to implement and adapt CM for HEVs. Findings contribute to a larger effort to identify effective adaptation strategies that improve healthcare delivery and engagement among Veterans that face heightened structural vulnerabilities and barriers to care.