Stimulants are involved in a substantial and growing percentage of the more than 100,000 overdose deaths in the United States each year. Methamphetamine and cocaine are increasingly present in overdoses involving fentanyl—fueling what has been called the “fourth wave” of the opioid overdose crisis. Unlike opioid use disorder, there are no FDA-approved medications to treat stimulant use disorder. However, a behavioral intervention called contingency management (CM) has been proven effective in managing a variety of substance use disorders, including tobacco, alcohol, cannabis, and stimulants. Also known as motivational incentives, CM reinforces positive recovery behaviors, including abstinence and retention in treatment programs, with financial rewards. Despite the considerable evidence for its efficacy, CM is underutilized in the treatment of stimulant use disorders, prompting recent commentators to call it “the most effective, evidence-based treatment you’ve never used.”
Written by Benicio Beatty, Ameya Komaragiri, and CHERISH Research Affiliate Janet Weiner, with contributions from Lyric Harris, the issue brief highlights contingency management, the most effective treatment for stimulant use disorder, and reviews the current barriers to its widespread use along with practice and policy strategies for increasing implementation.
This issue brief was prepared in advance of the Penn LDI/CHERISH Virtual Conference – Incentivizing Recovery: Payment, Policy, and Implementation of Contingency Management, on January 19th, 2024.