Contingency management for substance use disorders in the U.S. Veterans Health Administration: 2018-2022

Abstract: Introduction: Contingency management (CM) is one of the most effective interventions for substance use disorders (SUDs), including stimulant use disorder. In the United States, the Veterans Health Administration (VHA) led the largest-scale rollout of CM in the US to date, but little is known about characteristics of patients treated and CM clinical practices. Methods: In this retrospective cohort study, we used VHA electronic health records data to descriptively examine CM treatment course (e.g., number of visits, time between visits, duration of treatment episode) and characteristics of patients receiving CM for SUDs from 2018 to 2022. Results: From January 2018 to September 2022, 2844 patients received CM at 90 VA Health Systems (including 98 VA Medical Center, 7 community-based outpatient clinics, and 15 other sites). The median number of CM visits was 8 (mean = 10.17, SD = 8.12) visits over the course of 1.5 months (median = 45 days, mean = 57.46 days, SD = 62.65). The target substance was stimulants in 86.42 % of visits. Average age of patients was 52.29 years (SD = 12.10), with 55.06 % of patients experiencing homelessness or housing instability, and 97.50 % of patients diagnosed with more than one SUD. Compared to the year prior to the COVID-19 pandemic (03/2019-02/2020; mean = 957.33, SD = 157.71 visits/month), CM visits declined by 83.20 % in the year following the pandemic (03/2020-02/2021; mean = 160.83, SD = 164.14), and have yet to return to pre-pandemic levels. Conclusions: The CM rollout has been markedly successful in the VHA, with adoption across multiple VHA sites within a complex patient population, indicating the potential for effective, more widespread CM implementation. At the same time, there was a considerable reduction in CM care during the COVID-19 pandemic and CM has not yet returned to pre-pandemic levels. Moreover, only a small minority of VA patients with stimulant use disorder have received CM. Given increasing rates of overdose, including stimulant-involved overdose, it is important to increase CM provision in VHA and non-VHA settings.

Read the full article
Report a problem with this article

Related articles

  • More for Policy & Practice

    Defence and Veteran mental health and wellbeing strategy 2025 – 2030

    Abstract: People are the most important Australian Defence capability. The resilience, dedication and professionalism of the Defence and veteran community underpin our national security. We want Australians to be attracted to serving our nation in our Australian Defence Force, and confident that they and their families will be respected and well supported by their leaders, their mates and the broader Defence organisation. In addition, they should be safe in the knowledge that whatever may befall them during their service, they will be properly looked after, and their service acknowledged, respected and commemorated by a grateful nation. As such, it is our nation’s duty to empower and support their mental health and wellbeing. This means providing for our people and their families to serve well, live well and age well, no matter where they are on their Defence and veteran journey. This strategy adopts a preventive and holistic approach. In addition to early intervention and comprehensive care, it prioritises wellbeing from the day they sign up, until well after they’ve hung up their uniform for the last time. By embracing a life course approach, we honour the service and acknowledge the sacrifices made by the Defence and veteran community This strategy unites the Department of Defence and the Department of Veterans’ Affairs in their resolve to foster a culture of proactive wellbeing and mental health care. It leverages combined expertise and resources to ensure our Defence and veteran community receive the support they need during and after service. This strategy is complemented by action plans that describe the initiatives, programs and services that will achieve our goals and outcomes. This strategy will fortify Australia’s Defence capability by building a positive culture, with leadership that empowers self-agency and supports the wellbeing of Defence’s integrated workforce. Our approach will help Defence achieve the outcomes of the National Defence Strategy 2024 while improving recruitment and retention of personnel in the Australian Defence Force. We acknowledge the work of the Royal Commission into Defence and Veteran Suicide. The insights and reports of the Royal Commission, as well as other reports including the Productivity Commission’s: A Better Way to Support Veterans inform our wellbeing and suicide prevention initiatives, programs and services. This includes the co-design of a new agency focused on veteran wellbeing. I am proud to share with you the first joint Defence and Veteran Mental Health and Wellbeing Strategy. It provides a shared vision, goals and outcomes for meaningful change to empower every member of our Defence and veteran community to lead healthy and fulfilling lives. The journey ahead requires concentrated effort and unwavering dedication in order to build a more resilient and healthier Defence and veteran community. I sincerely thank all those who have provided input. You have helped shape the vision, goals, outcomes and priorities in this strategy in an effort to improve the mental health and wellbeing outcomes for those in the Defence and veteran community.

    Mental Health Well-Being