Rewiring Reward: Contingency Management as Treatment for Stimulant Use DisorderRewiring Reward: Contingency Management as Treatment for Stimulant Use Disorder
Addiction Practice Pod
Health care providers hear how contingency management programmes use rewards, group support and peer involvement to help people reduce stimulant use. The conversation covers clinical evidence, virtual and in-person group design, and the practical realities of making these services sustainable.
42:33•10 Nov 2026
Rewiring Rewards: Contingency Management for Stimulant Use Disorder
Episode Overview
- Contingency management offers immediate, tangible rewards for measurable behaviours, making it a highly effective treatment option for stimulant use disorder.
- CM groups use achievable SMART goals, optional urine testing and prize draws to build accountability, social support and honest self-reflection without punitive consequences.
- Peer involvement in designing and running groups increases trust, safety and engagement, especially when facilitators bring lived experience of HIV and substance use.
- Virtual CM programmes can successfully use attendance-based escalating rewards and emailed gift cards to reach people who cannot attend in-person groups.
- Sustainable funding and leadership support are essential, as successful CM programmes often become more costly over time due to higher attendance and more earned rewards.
“We really want to meet people where they're at. And one thing that's really important to say about contingency management is we only offer rewards. Slips can be part of recovery. We want to be here for you on your journey.”
Curious about how others navigate their sobriety journey? This episode of Addiction Practice Pod takes health care providers right into the nuts and bolts of contingency management (CM) for stimulant use disorder, blending science, lived experience and practical programme design. Host David Ball opens by framing stimulant use as a condition that rewires the brain’s reward pathways, making "positive reinforcement" a powerful tool. Peer navigator Mark Haggerty from St.
Paul’s Rapid Access Addiction Clinic explains how their Rewarding Change groups use achievable weekly goals, optional urine tests and gift-card prize draws to support people who use stimulants. As Mark puts it, "We really want to meet people where they're at... we only offer rewards... slips can be part of recovery.
We want to be here for you on your journey." You’ll hear how participants set SMART goals around health, leisure and recovery, and why the fishbowl-style prize draw creates excitement, accountability and social connection rather than simply "paying people to do what they should do". Mark’s story of a shy newcomer who slowly builds confidence, cuts down use and starts supporting other immigrants shows how CM can boost hope and self-esteem alongside reduced risk of overdose.
Co-host Dr Paxton Bach breaks down CM as a behavioural, evidence-based intervention grounded in operant conditioning, stressing that it’s "by far, the most effective treatment" available for stimulant use disorder in broad populations. Later, Amanda Chapman and Dr Anne Crawford walk through Island Health’s Rewarding Recovery programme, including virtual CM groups, escalating attendance-based rewards, integration with CBT relapse-prevention work, and the crucial role of peers in facilitation.
For busy clinicians, this episode offers concrete examples of funding models, group design, rolling entry and how to keep programmes running long enough for deeper psychosocial change to take root. If you’re wondering how to make stimulant care more engaging, humane and effective, could CM be the next tool you bring into your practice?
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