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

Handout - ORN Fall 2026 - Coughlin

Pdf Summary

This presentation reviews the stimulant use disorder (StUD) crisis and argues that contingency management (CM) should be a core treatment response. It notes that stimulants are involved in the majority of U.S. overdose deaths, often alongside fentanyl, and that people with StUD face serious psychiatric, medical, and social harms. Unlike opioid use disorder, StUD has no FDA-approved medication treatment.<br /><br />CM is described as a behavioral intervention that provides immediate rewards, such as gift cards or points, when patients verify recovery behaviors like drug-free urine tests or attending treatment. The presentation emphasizes that CM is the most effective evidence-based treatment for StUD, citing multiple meta-analyses showing stronger abstinence outcomes than other psychosocial approaches. CM also appears durable after incentives end and works well for patients with co-occurring opioid use disorder.<br /><br />A major focus is a new retrospective cohort study of 1,481 matched veterans with StUD in the Veterans Health Administration. Using linked electronic health record and mortality data, the study found that veterans who received CM had a 41% lower risk of death within one year compared with matched controls (adjusted hazard ratio 0.59). The result remained similar after sensitivity analyses, including exclusion of COVID-19 deaths.<br /><br />The presentation addresses common concerns about CM, arguing that incentives do not reduce intrinsic motivation, are not simply “buying” drug use, and are manageable under SAMHSA protocols. It also reviews implementation progress in the VA, California, Michigan, and other states, while noting that sustainable financing remains a major barrier because CM is not routinely billable in most Medicaid or block grant systems.<br /><br />Overall, the presentation concludes that CM is settled science for StUD, and that broader adoption could meaningfully reduce preventable deaths.

Keywords

stimulant use disorder

contingency management

overdose deaths

behavioral intervention

abstinence outcomes

Veterans Health Administration

retrospective cohort study

mortality reduction

SAMHSA protocols

implementation barriers