Treatment Program for Veterans Shows 41% Reduction in Fatalities with Contingency Management Utilization

A new study published in the American Journal of Psychiatry finds that contingency management (CM)—a behavioral treatment that rewards individuals for meeting treatment milestones—can significantly reduce the risk of death among people with stimulant use disorder.

Researchers analyzed records from nearly 3,000 veterans diagnosed with stimulant use disorder who received care through the Veterans Health Administration (VHA), the largest integrated healthcare system in the United States. They found that participants who received contingency management were 41% less likely to die within one year compared to similar patients who did not receive the intervention.

The study showed that CM was associated with a substantially lower risk of all-cause mortality—even after accounting for factors such as hospitalization, co-occurring conditions, and housing instability.

The authors note that the magnitude of benefit was similar to that seen with medications for opioid use disorder, underscoring CM’s potential as a life-saving tool in addressing stimulant-related harms. While stimulant-involved overdose deaths continue to rise across the United States, there are currently no FDA-approved medications for treating stimulant use disorder. Expanding access to contingency management in both public and private health systems could help close this treatment gap and improve survival outcomes for people affected by stimulant use.

Contingency management (CM) involves the use of positive rewards or incentives to facilitate behavior change, such as gift cards, vouchers, and/or social recognition, when the individual exhibits the desired behavior, such as negative urine tests or participation in treatment activities. Previous research has found CM to be effective in treating SUDs, with lower dropout rates and improved other treatment outcomes (Dutra et al., 2008).

Key Findings

• Veterans who received contingency management were 41% less likely to die within a year compared to those who did not receive CM.

• The reduction in mortality risk remained significant after adjusting for medical and psychiatric comorbidities.

• Mortality benefits were comparable to those observed with buprenorphine treatment for opioid use disorder.

• Implementation of CM in the VHA demonstrates the potential for large-scale adoption in community and public health systems.

Read More

The Article

Coughlin, L. N., Tomlinson, D. C., Zhang, L., Kim, H. M., Frost, M. C., Khazanov, G., McKay, J. R., DePhilippis, D., & Lin, L. A. (2025). Contingency management for stimulant use disorder and association with mortality: A cohort study. American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.20250053

Reference:

Dutra, L., Stathopoulou, G., Basden, S. L., Leyro, T. M., Powers, M. B., & Otto, M. W. (2008). A meta-analytic review of psychosocial interventions for substance use disorders. American Journal of Psychiatry, 165(2), 179-187. https://doi.org/10.1176/appi.ajp.2007.06111851