Patient characteristics associated with receipt of contingency management for stimulant use disorder in the Veterans Health Administration

Background

Contingency management (CM) is the most effective available treatment for stimulant use disorder (StUD). The Department of Veterans Affairs (VA) rolled out the largest national CM implementation effort to date, but ongoing efforts are needed to increase CM receipt. To inform these efforts, it is important to understand the reach of CM implementation across patient characteristics. This exploratory analysis examined whether patient characteristics are associated with CM receipt among VA patients with StUD.

Methods

We extracted electronic health record data for patients with diagnosed StUD who received care 10/1/20–9/30/22 at VA facilities that had begun CM implementation (N = 93,960); CM receipt was measured during the year following patients’ index visit (first visit during 10/1/20–9/30/22). We examined whether sociodemographic characteristics, comorbidities, and prior non-CM StUD treatment utilization were associated with likelihood of receiving CM using multivariable logistic regression.

Results

Only 1 % (n = 1113) of the sample received CM. Patients were more likely to receive CM if they were age 30–64 (compared to age 18–29), Black (compared to White), service connected, experiencing homelessness/housing instability, had alcohol, opioid or other drug use disorders, or had more prior non-CM StUD psychotherapy visits or more prior StUD medication management visits. Patients were less likely to receive CM if they lived in rural areas, had posttraumatic stress disorder, or had ≥ 3 Elixhauser comorbidity conditions.

Conclusions

Ongoing efforts to increase CM receipt are needed, including increasing access for patients in rural areas and further work to understand specific barriers for patients with PTSD or a higher number of comorbidities.