Contingency Management for Stimulant Use Disorder: Progress, Challenges, and Recommendations
Abstract
The United States is currently in the fourth wave of the overdose crisis wherein stimulants together with fentanyl are the major drivers of overdose deaths. To date, there has been limited effort outside the US Veterans Administration Health System health system to disseminate evidence-based treatment for people with stimulant use disorder. Contingency management, a behavioral intervention in which positive reinforcement is provided for a target behavior indicating treatment progress, has decades of empirical support but limited implementation in real-world, non-US Veterans Administration Health System settings. The purpose of the report is to provide an overview of contingency management, the barriers to adoption, and recommendations for overcoming these barriers.
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One systematic review found contingency management effective in reducing cocaine use among adults.
“and one showed effectiveness in reducing cocaine use in adults.46”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [46]
Strong evidence indicates that contingency management effectively increases treatment engagement and reduces stimulant use.
“There is strong evidence that CM is an effective intervention for increasing treatment engagement and reducing stimulant use.”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [46]
Contingency management has shown the greatest effectiveness among studied interventions for stimulant use disorder and is the current standard of care.
“Contingency management (CM) has demonstrated the best effectiveness in the treatment of stimulant use disorders (StUDs) compared to any other intervention studied and represents the current standard of care.”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [46]
Cites
Rawson, R. A., McCann, M. J., Flammino, F., Shoptaw, S., Miotto, K., Reiber, C., & Ling, W. (2006) · Addiction · doi:10.1111/j.1360-0443.2006.01312.x · Cited by 238 · see citing works
Self-citationContingency management for the treatment of methamphetamine use disorder: A systematic review
Brown, H. D., & DeFulio, A. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108307 · Cited by 171 · cited 1× · see citing works
“The research evidence supporting the use of CM for the treatment of individuals with cocaine and methamphetamine use disorder is extensive (for reviews, see AshaRani et al., 2020; Bentzley et al., 2021; Bolivar et al., 2021; Brown & DeFulio, 2020; De Crescenzo et al., 2018).”
Bentzley, B. S., Han, S. S., Neuner, S., Humphreys, K., Kampman, K. M., & Halpern, C. H. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.8049 · Cited by 161 · see citing works
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The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder
(2024) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001299 · Cited by 78 · see citing works
Psychosocial interventions for stimulant use disorder
Minozzi, S., Saulle, R., Amato, L., Traccis, F., & Agabio, R. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011866.pub3 · Cited by 32 · see citing works
Navigating Evidence, Challenges, and Caution in the Treatment of Stimulant Use Disorders
Bahji, A., Danilewitz, M., & Crockford, D. (2023) · Brain Sciences · doi:10.3390/brainsci13101416 · Cited by 9 · see citing works
- Authors
- Rawson, R. A., Erath, T. G., Chalk, M., Clark, H. W., McDaid, C., Wattenberg, S. A., Roll, J. M., McDonell, M. G., Parent, S., & Freese, T. E.
- Affiliations
- University of Vermont (US)
- Corresponding author
- Erath, Tyler G.
- ORCID
- Venue
- Journal of Ambulatory Care Management
- Published
- 2023-02-03
- Volume
- 46
- Issue
- 2
- Pages
- 152-159
- ISSN
- 0148-9917 (ISSN-L)
- OpenAlex
- W4319295363
- Cited by
- 41
- References
- 3
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 9 · 2023: 5
- FWCI
- 8.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Ambulatory Care Management (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of General Medical Sciences (P20GM103644)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- contingency management, stimulant use disorder, positive reinforcement, behavioral interventions, opioid epidemic, fentanyl, implementation barriers, dissemination of evidence-based treatment
- MeSH terms
- Central Nervous System Stimulants, Behavior Therapy, Humans, United States, Substance-Related Disorders
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