Trish Caldwell

Session Description: Stimulant-involved overdose deaths have climbed dramatically over the past decade, yet unlike opioid use disorder, there is currently no FDA-approved medication for stimulant use disorder. Contingency management (CM) - a positive reinforcement-based intervention that rewards verified abstinence - remains the only treatment modality with robust, decades-long evidence of efficacy for stimulant use disorder. Despite this, CM remains dramatically underutilized in community-based outpatient settings, often due to funding restrictions, unfamiliarity with clinical implementation, and outdated skepticism about incentive-based treatment. This session presents findings from a pilot outpatient CM program, with a clinical focus on how the intervention was implemented, trained, and monitored for fidelity to the evidence base. Presenters will walk through the core clinical components of an effective CM protocol - including reinforcement schedules, incentive structures, and verified abstinence monitoring - as well as the staff training process required to build clinician competency and confidence in delivering CM. Particular attention will be given to fidelity monitoring: how the program tracked adherence to the evidence-based protocol over time to ensure the intervention retained its clinical effectiveness as it scaled. Early pilot data on patient engagement, abstinence rates, and treatment retention will be presented alongside a discussion of common clinical and operational barriers - including funding constraints, staff training needs, and program implementation struggles- and how these were addressed in a real outpatient setting. The session closes with a direct call to action: behavioral health providers, funders, and policymakers must move beyond treatment-as-usual and expand access to CM as the evidence-based standard of care for stimulant use disorder. Attendees will leave with concrete, clinically grounded guidance for training staff and launching CM programs with fidelity to the evidence base. This session is designed for clinical directors, outpatient program leaders, counselors, therapists, and behavioral health providers treating stimulant use disorder.