ORN Fall 2026 - Contingency Management for Stimulant Use Disorder: New Evidence for Reducing Mortality-2026-09-09

Video Transcription

Video Summary

This webinar, moderated by Julie Kimmick and presented by Dr. Laura Coughlin of the University of Michigan, focused on contingency management (CM) for stimulant use disorder and new evidence that it may reduce mortality. Dr. Coughlin explained that stimulant use disorder remains a major driver of overdose and other harms, often overlapping with fentanyl exposure and opioid use disorder. Because there are no FDA-approved medications for stimulant use disorder, behavioral treatments are especially important.<br /><br />CM was described as a simple, evidence-based approach that uses immediate, tangible rewards to reinforce recovery behaviors such as stimulant-negative urine tests or attending treatment. The talk emphasized that CM works through prompt positive reinforcement, not punishment, and can be combined with therapies like CBT, motivational interviewing, and medication for opioid use disorder.<br /><br />Dr. Coughlin reviewed decades of research showing CM consistently improves abstinence, treatment attendance, and medication adherence, including among people receiving MOUD. She also addressed misconceptions, noting that CM does not undermine intrinsic motivation, effects can persist after incentives end, and incentives are not typically used to buy drugs. She highlighted that major organizations, including ASAM, now consider CM the standard of care for stimulant use disorder.<br /><br />The centerpiece of the talk was a VA cohort study linking CM to a 41% reduction in all-cause mortality over one year among veterans with stimulant use disorder. Finally, she discussed implementation barriers and funding pathways, including SAMHSA, Medicaid demonstrations, and state opioid settlement funds, arguing that the field already knows CM works and now needs to scale it.

Keywords

contingency management

stimulant use disorder

mortality reduction

behavioral treatment

positive reinforcement

urine testing

treatment adherence

medication adherence

opioid use disorder

substance use disorder