Contingency Management for Stimulant Use Disorder and Association With Mortality: A Cohort Study

While opioid overdose has begun to decrease in recent years, stimulant overdose has continued to increase and has not been adequately addressed. Unlike opioid use disorder, there are no medications approved by the U.S. Food and Drug Administration to treat stimulant use disorder (StUD). The most effective treatment is contingency management (CM), a behavioral intervention that provides tangible rewards to reinforce target behaviors, such as biochemically verified abstinence. Despite the effectiveness of CM on near-term substance use behaviors, the long-term impact on key outcomes such as mortality are unclear. The objective of this work was to examine whether patients with StUD who receive CM have a decreased risk of mortality.

This was a retrospective cohort study of patients with StUD who received or did not receive CM, using linked electronic health records and death records in the largest integrated health system in the United States, the Veterans Health Administration (VHA), from July 2018 through December 2020. The primary outcome was mortality in the year following the index CM visit. All-cause mortality data were obtained from the National Death Index and linked to electronic health record data. Adjusted hazard ratios were estimated using stratified Cox proportional hazards models.

A total of 1,481 patients with StUD who received CM were included alongside 1,481 matched control subjects. Over the 1-year follow-up period, those who received CM were 41% less likely to die (adjusted hazard ratio=0.59, 95% CI=0.36, 0.95) than those who did not receive CM.

This study provides the first evidence that CM use in real-world health care settings is associated with reduced risk of mortality among patients with StUD.