The overdose epidemic in the U.S. has surged, with over 106,000 deaths reported in 2023. While initially driven by opioids, recent trends show a significant rise in stimulant use, including cocaine and methamphetamine, comprising nearly 50% of overdose-death toxicology reports by 2021. This “fourth wave” of the crisis has prompted researchers to explore new treatment methods.
Contingency management (CM), developed in the 1990s, provides incentives like gift cards to patients who abstain from drug use, verified through testing. Although no FDA-approved medications exist for treating cocaine and methamphetamine addiction, CM has shown promise as a behavioral therapy for stimulant use disorder. Dr. Gabriela Khazanov, a research associate with the Penn Center for Mental Health, and Dr. James McKay, a professor of psychology in psychiatry, recently published a viewpoint in the journal Addiction that makes the case for refining CM protocols and increasing utilization.
Their recommendations include extending treatment durations, like California's 24-week CM program (as opposed to a more common 12-week program), and propose that Medicaid and private insurers cover CM services. Utilizing federal or state funds for patient incentives and allowing flexibility for patients to reengage in CM after substance use is also suggested.
Critics argue that CM is paying patients for behaviors they should pursue independently. However, Khazanov and McKay maintain that incentivizing abstinence is effective and acceptable to both patients and providers. Khazanov states, “This is an attempt to adapt CM to our current situation, as stimulant use is rising at a rate faster than current CM protocols can keep up.”
Read more here.
Addiction Policy Forum's video explainer on contingency management walks through the components of this important treatment for substance use disorders.
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