Provision of recommended treatment for stimulant use disorder in United States substance use treatment facilities.
Level 4 - case-series / case-control
Cross-sectional survey analysis of treatment facility characteristics and practices
PubMed 42442252 · doi:10.1016/j.drugpo.2026.105428
What was done
Researchers analyzed cross-sectional data from the 2024 National Substance Use and Mental Health Services Survey (N-SUMHSS) to examine the provision of guideline-recommended stimulant use disorder (StUD) treatments across U.S. treatment facilities. Outcomes measured were facility self-reports of frequent use of contingency management/motivational incentives (CM/MI) for non-opioid substances alone and combined with other recommended psychosocial therapies (cognitive behavioral therapy [CBT], community reinforcement approach [CRA], or Matrix Model [MM]). Multivariable logistic regression was used to identify associated facility- and state-level characteristics.
What was found
Less than half of facilities reported frequent use of recommended StUD treatments: 42% for CM/MI alone, 41% for CM/MI plus CBT, 25% for CM/MI plus MM, and 8% for CM/MI plus CRA. Provision of CM/MI alone or in combination was positively associated with state licensure/certification, accepting state-financed insurance, offering opioid agonist treatment, and higher state percent rural population (except CM/MI+CRA). Provision was negatively associated with primarily providing substance use services (versus combined mental health and substance use services), private non-profit ownership (versus private for-profit), accepting Medicare or Medicaid, cash/self-pay only payment, and higher state-level stimulant-involved overdose mortality rates.
Why it matters
Despite contingency management being the most effective available intervention for stimulant use disorder, most U.S. facilities do not routinely offer it or recommended combination regimens. These findings highlight key structural and policy barriers to evidence-based care amid rising stimulant-related harms.
Limits
The abstract does not state the total number of facilities analyzed (n). The findings rely on facility self-reports of "frequent use" rather than objective measures of clinical fidelity, patient-level receipt of care, or treatment outcomes.
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- contradicts Contingency management for addiction treatment is covered by insurance in most places.