Stimulant use disorder is widespread, but unlike opioids, it lacks a simple antidote. Meth and cocaine create different risks, but both heighten psychosis and destabilize lives. This episode dives into the evidence: contingency management—direct financial reinforcement for behavior change—stands as the most effective tool we have. It is controversial, but results are undeniable. Paychecks for progress may sound radical, yet they stabilize lives more reliably than punishment ever has. We ask: if the evidence is clear, why is the system so slow to implement it?

By Niklas S. Osterman BHPRN, MA Addiction Specialist