A groundbreaking study from the University of Michigan and the Veterans Administration (VA) Ann Arbor Healthcare System has revealed a powerful correlation between contingency management (CM) and a significant reduction in mortality rates among veterans struggling with stimulant use disorders. This innovative approach, which uses monetary incentives such as cash or gift certificates to motivate patients to abstain from drug use, offers new hope in tackling some of the deadliest challenges faced by individuals recovering from addictions to methamphetamine, cocaine, and other stimulants.
The research, published in the American Journal of Psychiatry, offers compelling real-world evidence that CM is not only effective for substance use disorder treatment but also dramatically improves survival outcomes. The study tracked a large cohort of veterans diagnosed with stimulant use disorders between mid-2018 and late 2020, analyzing digital health records to compare mortality rates between those receiving CM as part of their treatment and a closely matched control group who did not.
Results were striking: veterans engaged in CM exhibited a 41% lower risk of death within one year of starting treatment compared to their counterparts who did not receive this intervention. Moreover, the study observed a 33% reduction in overdose deaths and a 42% decrease in deaths specifically associated with stimulant use. These figures highlight CM’s potential as a life-saving measure in a patient population notoriously at high risk for early death.
Contingency management’s success lies in its behavioral reinforcement model, where patients earn rewards for maintaining drug-free urine screens and attending treatment sessions. Unlike many pharmacologic treatment options, which are limited or non-existent for stimulant use disorders, CM delivers tangible and immediate positive feedback that can sustain motivation during the difficult early phases of recovery. This makes CM uniquely suitable for stimulant addiction, a condition that lacks FDA-approved medication-based therapies.
The study cohort consisted of 2,962 veterans, predominantly male with an average age of 52. Noteworthy was the high prevalence of co-occurring disorders: over 50% had concurrent alcohol use disorder, one-quarter had opioid use disorder, and nearly three-quarters suffered from additional significant physical or psychiatric conditions. The complexity of this population underscores the challenges faced by clinicians, but also the promise of CM as a multifaceted tool capable of encouraging engagement with recovery even among the medically and psychiatrically vulnerable.
Interestingly, the study also found that veterans receiving contingency management were more likely to be hospitalized during the year-long observation period, including psychiatric hospitalizations. Dr. Lara Coughlin, lead author of the study, suggests this pattern might reflect more comprehensive engagement with mental health care, which could contribute to better survival. Psychiatric hospitalizations may provide critical support by addressing underlying or co-occurring conditions that jeopardize sustained recovery from stimulant use.
Despite these encouraging findings, the implementation of CM across the United States remains limited. Current regulatory restrictions, including caps on incentive amounts, and lingering stigma around “rewarding” individuals with substance use disorders, have hampered broader adoption. Only five states have obtained waivers to deploy CM through Medicaid programs, and private insurance coverage is uneven and inconsistent. Michigan’s ongoing pilot program utilizing digital CM through smartphones and virtual gift cards could become a national model to increase accessibility and reduce logistical barriers.
The VA’s early adoption of contingency management predates most other health systems by nearly a decade, enabling researchers like Dr. Coughlin and her colleagues to generate robust evidence on its effectiveness. Their work emphasizes the importance of expanding CM availability not only within the VA system but also in broader healthcare settings. Given that stimulant-related deaths now account for half of all overdose fatalities in the United States, the urgency for effective treatments is greater than ever.
Moreover, the digital transformation of CM shows promise in overcoming traditional hurdles. Virtual incentives delivered via mobile platforms can streamline administration, enhance privacy, and boost patient engagement, especially among populations who might face challenges attending in-person clinics. The Michigan pilot programs targeting people with substance use disorders and Medicaid-enrolled pregnant individuals who smoke tobacco are pioneering these tech-driven interventions.
The magnitude of risk reduction associated with CM parallels treatment outcomes seen with buprenorphine for opioid use disorder, a gold-standard pharmacotherapy. This comparison underscores CM’s potential as an equally vital tool in the addiction treatment arsenal, particularly for stimulant users. As CM programs expand and data accumulate, the paradigm for addiction care may shift to embrace behavioral economic strategies alongside traditional medical models.
The VA-funded study, supported by the Office of Mental Health and Suicide Prevention, also highlights the intersection of addiction treatment with public health priorities around suicide prevention, mental health equity, and comprehensive care integration. It advocates a holistic approach that reinforces recovery while addressing comorbidities that complicate stimulant use disorder.
In conclusion, contingency management represents a scientifically supported, pragmatic, and effective intervention capable of dramatically reducing mortality for veterans facing stimulant addiction. This approach’s scalability and adaptability through digital health platforms suggest it could reshape future substance use disorder treatments nationally and globally. For a patient population historically underserved by medication-based options, CM offers a much-needed lifeline, translating behavioral science into life-saving care.
Subject of Research: People
Article Title: Contingency Management for Stimulant Use Disorder and Association With Mortality: A Cohort Study
News Publication Date: 10-Sep-2025
Web References:
DOI: 10.1176/appi.ajp.20250053
References:
American Journal of Psychiatry
Keywords: Addiction, Substance related disorders, Health care, Health care delivery, Health care policy, Preventive medicine
