75. Contingency Management for Stimulant Use and Mortality75. Contingency Management for Stimulant Use and Mortality
Addiction Medicine Journal Club
Dr. Sonya Del Tredici and Dr. John Keenan review a large VA study linking contingency management for stimulant use disorder with reduced mortality and discuss the practical barriers to using this approach. They also talk through current telemedicine rules for addiction treatment and share real-life stories from their own clinical practice.
28:21•4 May 2026
Prizes, Telemedicine and Fewer Deaths: Contingency Management for Stimulant Use
Episode Overview
- Contingency management in a large VA cohort was associated with roughly a 41% reduction in all-cause mortality for people with stimulant use disorder.
- The VA programme uses fishbowl-style prize draws and coupons worth about $200 over 12 weeks, often redeemed for snacks, food and basic items.
- Patients in contingency management had higher rates of hospitalisation, which the hosts suggest may reflect better engagement with care rather than harm.
- Telemedicine flexibilities allowing controlled substance prescribing without in-person visits, including audio-only care for opioid use disorder, have been extended through 2026.
- Major barriers to wider use of contingency management include tax reporting rules, anti-kickback concerns, limited funding mechanisms, and stigma about incentivising abstinence.
“the study provides the strongest real-world evidence to date that contingency management for stimulant use disorder is associated with significant reduction in all-cause mortality.”
How do different strategies aid in addiction recovery? This episode of Addiction Medicine Journal Club zooms in on contingency management for stimulant use disorder and why it might literally save lives. Dr. Sonya Del Tredici and Dr. John Keenan break down a large Veterans Health Administration cohort study looking at contingency management and mortality in people with stimulant use disorder.
You’ll hear how this prize-based approach – think fishbowls, coupons, and escalating rewards for negative drug screens or group attendance – is linked with a 41% reduction in all‑cause mortality. As Sonya sums it up, "the study provides the strongest real-world evidence to date that contingency management for stimulant use disorder is associated with significant reduction in all-cause mortality." The conversation stays grounded in everyday clinical reality.
The hosts talk through the VA’s long-running programme, the practicalities of running 12‑week groups where patients earn about $200 in commissary-style rewards, and why such a cheap intervention still isn’t widely available. Barriers like tax reporting rules, anti‑kickback concerns, lack of Medicaid mechanisms to fund incentives, and social stigma about “paying people to stay off drugs” all come under the spotlight. Alongside the journal chat, there’s a lively segment on telemedicine for addiction treatment.
They swap stories about audio‑only visits, dodgy Wi‑Fi, patients calling from buses and factory floors, and the relief that COVID‑era prescribing flexibilities for controlled substances have been extended through 2026. This episode is aimed squarely at clinicians and trainees in addiction medicine and primary care who want research they can use on Monday morning, but it’s delivered with enough humour and honesty to keep you engaged after a long clinic day.
If you’ve ever wondered whether contingency management is worth the hassle, this conversation might have you rethinking what a "simple" prize can do – and questioning why such programmes aren’t standard everywhere.
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