Pilot implementation of contingency management for stimulant use disorder in a Veterans Affairs homeless program primary care clinic

Background Contingency Management (CM) is the most effective intervention to treat stimulant use disorder but may not be accessible to people experiencing homelessness. Our goal was to tailor CM to Veterans experiencing homelessness in a Primary Care Clinic.Methods We recruited Veterans on Oahu, Hawaii, in the Homeless Program who reported methamphetamine use disorder. CM consists of twice weekly visits for 12 weeks. Veterans drew a prize for each test negative for methamphetamine.Results 24 Veterans enrolled and 18 completed at least one CM visit. 70.9% of tests collected were negative for methamphetamine, but median attendance overall was only six visits. Assuming a full 24-session course of treatment and assigning a positive test to unexcused absences, dropouts or test refusals, only 24.8% of tests were negative. Staff time required for a treatment course was 8 h per Veteran in clinic and over 27 h per Veteran if testing done at an encampment or at supported housing.Conclusions CM can feasibly be offered in a Primary Care setting for Veterans in the Homeless Program, but the intervention requires further study to improve attendance and abstinence.