The United States is currently facing a critical juncture in the ongoing drug overdose crisis. We've entered what experts are calling the "fourth wave," characterized by the increasing prominence of psychomotor stimulants like cocaine and methamphetamine alongside opioids. Recent data paints a stark picture: Stimulants were involved in nearly 50 percent of overdose deaths in 2021, with over 19,000 deaths involving stimulants alone. This alarming trend underscores the urgent need for effective treatments targeting stimulant use disorders (StimUD).
Unlike opioid addiction, for which several effective medications exist, there are currently no FDA-approved medications for the more than 3 million Americans struggling with stimulant addiction. However, a behavioral intervention known as contingency management (CM) has shown remarkable promise in addressing this gap.
Contingency management is an evidence-based approach that involves providing tangible reinforcers (typically gift cards) contingent on achieving target behaviors, such as producing stimulant-negative urine samples. The core components of CM protocols include:
1. An observable and measurable target behavior (abstinence from stimulant use)
2. Delivery of........