The Biden administration made a significant move on Wednesday by removing a major barrier for health providers wanting to offer contingency management as a form of addiction treatment, particularly for stimulants like methamphetamine. Contingency management involves providing financial incentives to drug users in exchange for reduced substance use. While this approach has been controversial, numerous studies have shown its effectiveness in curbing drug consumption. Several states, including California, Montana, West Virginia, and Washington, already include contingency management in their Medicaid programs.
Despite its proven effectiveness, federal grants supporting contingency management have been limited to $75 per year, which experts and providers argue is inadequate for promoting behavioral change. With the clock ticking on the current administration, the Biden administration announced that grants from the Substance Abuse and Mental Health Services Administration can now fund contingency management services up to $750 annually. These payments must be made in the form of vouchers or gift cards, not in cash.
Previously, SAMHSA had been hesitant to raise the cap on grants, citing concerns about potential violations of federal anti-kickback laws. However, with the rise in stimulant use, particularly meth and cocaine, contingency management has become a critical tool in addressing the nation’s drug crisis. While medications like methadone and buprenorphine exist for treating opioid addiction, there is currently no approved medication for stimulant addiction.
SAMHSA stated in a bulletin announcing the change that contingency management is considered a primary intervention for the over 4 million people who meet diagnostic criteria for a stimulant use disorder. This decision follows years of advocacy from proponents who argued that providing only $75 per year was ineffective. The Biden administration’s move not only has financial implications but also carries symbolic weight, signaling strong federal support for contingency management and potentially influencing private insurers and health providers to adopt the intervention.
Prominent contingency management advocates, including former SAMHSA official Westley Clark, retired National Association for Behavioral Healthcare leader Sarah Wattenberg, DynamiCare’s chief medical officer David Gastfriend, and former federal drug policy official and Stanford researcher Keith Humphreys, have praised the decision. Humphreys called it a “huge advance” because contingency management is the only treatment that has been proven effective for addiction to cocaine and methamphetamine.
The Biden administration’s action marks a significant step in addressing the growing crisis of stimulant addiction and provides hope for those struggling with substance use disorders.
