Contingency Management Treatment for Stimulant Use Disorder
In recent years, at least 5.3 million people in the US have misused stimulant drugs. Overdose deaths involving stimulants have now surpassed those from prescription opioid painkillers and heroin. Despite the growing drug epidemic facing us today, significant advancements in substance use treatment have made recovery more possible than ever before. However, there are fewer treatment options for stimulant use disorder compared to opioids, for example.
While medication is available for opioid use disorder, there are no FDA- approved medications for stimulant use disorder. Despite decades of research, effective medications are simply not available to people with stimulant use disorder despite their use in treating other addictions, e.g., opioids, alcohol, and nicotine use disorder. Furthermore, patients who obtain counseling for stimulant use disorder have high relapse rates. This does not mean that there are no options for the 5.3 million people living with stimulant use disorder. On the contrary, contingency management has repeatedly been shown to be effective. Most importantly, contingency management is actually readily available for stimulant use treatment today.
DEFINING CONTINGENCY MANAGEMENT
Contingency management (CM) is a therapeutic approach that offers incentives to individuals in exchange for desired behavioral changes. Developed according to the principles of operant conditioning, CM accesses the pleasure-reward pathways in the brain, seeking to replace drug-seeking behavior with more positive, recovery-oriented behaviors. While contingency management has over 50 years of research supporting its efficacy, it has been underutilized for the treatment of stimulant use disorder, something DynamiCare is committed to changing.
Effective contingency management therapy programs for substance use disorder function under a financial rewards model. What this means is that meaningful monetary incentives are offered for desired behaviors. This approach is an incredibly successful therapy option in both research and in practice - typically doubling abstinence rates.
However, financial restraints, stigma, and even lack of training are all common reasons why facilities choose not to implement CM. That said, in the fight against stimulant use disorder, contingency management may just be the best choice and the best chance for people struggling with stimulant use disorder.
CONTINGENCY MANAGEMENT & STIMULANT USE
While contingency management is particularly effective in treating a wide variety of substance use disorders, people with stimulant use disorder are in dire need of an effective treatment option that can either stand alone or pair with their traditional treatment in order to achieve recovery in the same way that medication options can. Whereas a growing number of people with substance use disorders receive some form of medication-assisted treatment (MAT), those with stimulant use disorder are not so lucky.
Buprenorphine (e.g., Suboxone) and methadone have had success in the treatment of opioid use, but equivalent medications do not exist for stimulants like cocaine, ecstasy, and methamphetamines.
Research into MAT for stimulant use is still new, and there is a lack of consensus as to whether or not stimulant MAT is even possible due to the nature of these types of drugs. This is where contingency management can bridge the gap. In one study on the effectiveness of CM for stimulant use, when tested against standard care alone, patients who underwent contingency management-based care were four times more successful than those who did not.
Another study that compared CM with traditional cognitive behavioral therapy as a treatment method for stimulant use found that contingency management is not only more effective in producing successful outcomes, but it also increases patient retention and engagement.
THE BENEFITS OF CONTINGENCY MANAGEMENT
When looking to address the stimulant use crisis specifically, contingency management offers a number of unique benefits.
In an extensive meta-analysis from PLOS Medicine, we see clinical outcomes from 50 studies on cocaine and stimulant use. Results consistently show a reduction in relapse when utilizing contingency management versus standard treatment alone. This can aid in the prevention of future health problems associated with long-term stimulant use, which has the potential to reduce future medical bills.
Its ability to create these sustained periods of abstinence would suggest that participants are more likely to continue with and benefit from aftercare programming. This is beneficial to the facilities providing treatment. Here are some of the primary advantages of CM for stimulant use disorder:
It allows those who are struggling with stimulant use to focus on healthy reward-seeking behaviors as opposed to unhealthy ones
Unlike traditional in-person models, remote CM via the DynamiCare app can be utilized at home, so that patients can continue working and caring for their families
CM has the ability to create lasting recovery. In DynamiCare’s own model, we transition patients off of financial incentives after about 6 months of treatment, yet most continue with successful engagement for much of the remaining 12 month care protocol
When patients are experiencing other types of substance use, such as opioids, MAT can help by offering medication alternatives. Stimulants, however, do not offer the option of stabilization via controlled medication with the goal of recovery. Contingency management is a desirable solution because it offers an extra level of support through incentivization
This programming is shown to be financially beneficial to providers, facilities, and insurance payers
State funding is available for centers looking to implement CM programs. California, Maryland, Massachusetts, New Jersey, and West Virginia have launched or are launching contingency management programs for those struggling with stimulant use disorder
CONTINGENCY MANAGEMENT WITH DYNAMICARE
While the benefits of CM are dramatic and its benefits proven, it’s still only utilized by about 10% of treatment programs in the U.S. Lack of funding, frequent drug testing requirements, lack of staff training, and complexity of reward management seem to be deterring most programs from participating. The goal of DynamiCare is to break down these barriers and make it possible for more treatment centers to adopt CM as a valuable option for treatment. Our fully-automated platform is convenient and allows for random substance tests, GPS treatment attendance tracking, and affordable, desirable incentives.
DynamiCare seeks to create strategies and rewards that will establish healthy, lasting habits and sustained recovery from stimulant use disorder.
To learn more about the enrollment process, fill out our pre-enrollment form.