Feasibility and Acceptability of a Pilot Contingency Management Intervention for Stimulant Use Disorder in a Hospital Setting

OBJECTIVES: Contingency management (CM) is effective for stimulant use disorder (STUD) in community settings. This pilot study assessed the feasibility, acceptability, and preliminary effectiveness of a CM intervention for STUD in a Vancouver, Canada hospital that supports patients to complete medical treatment despite ongoing substance use. METHODS: Medical inpatients with STUD received a CM intervention involving twice-weekly gift card rewards for stimulant-negative urine drug tests and/or achieving SMART health care goals. Feasibility was defined by recruitment, retention, engagement until discharge, and lack of interference with medical care. Acceptability was assessed through weekly and exit surveys; preliminary effectiveness was determined through self-reported stimulant use via Timeline Followback and survey data on substance use and hospital experience. RESULTS: Forty-two participants enrolled; 21 (50%) had severe STUD and 34 (81%) had concurrent opioid use disorder. Thirty-five participants engaged with CM; 33 (79%) participated until discharge, contributing 227 encounters (median 5 per participant, interquartile range 3.5-8). Weekly surveys indicated high acceptability, including improved hospital experience (90%, 86/96 responses) and desire to continue CM postdischarge (97%, 93/96 responses). Twenty (57%) reported decreased stimulant use compared with baseline Timeline Followback. Exit interviews highlighted CM as motivating behavioral change. Staff (n=6) reported improved patient engagement and no negative impact on care delivery. DISCUSSION: CM for STUD appears feasible and acceptable in hospital settings and may improve patient experience and engagement. Further research is needed to examine the effectiveness of hospital-based CM on patient outcomes during admission and postdischarge.