Lara Coughlin’s research on substance use disorders and addiction care informs policy and practice at the local, state, and national levels.
Substance use disorders can lead people to choose the short-term rewards of substance use over the long-term benefits of not using.
Substance use disorders remain a significant public health concern in the United States. In 2024, over 48 million people age 12 or older had a substance use disorder (SUD), with only 1 in 5 of those classified as in need of treatment ultimately receiving it. Without proper care, those with an SUD are at an increased risk of serious harm, including infectious disease, worsening physical and mental health, and overdose-related death.
Lara Coughlin, Ph.D., associate professor of psychiatry at Michigan Medicine, examines the accessibility and effectiveness of substance-related addiction care, including contingency management (CM) and other behavioral economics-based approaches to recovery. As co-director of the Michigan Innovations in Addiction Care through Research & Education (MI-ACRE) program and the Mental Health Equity Faculty Lead at the Eisenberg Family Depression Center, Coughlin actively engages with policy stakeholders and other health leaders to inform treatment guidelines and improve addiction care across the U.S. In recognition of her many contributions and the impacts of her work, Coughlin was named a 2026 recipient of the U-M Institute for Healthcare Policy & Innovation’s Policy Impact Award.
Incentives for improvement
People with SUDs often choose the short-term rewards of substance use over the long-term benefits of abstaining or using less. Behavioral economics-based approaches to addiction care, such as CM, address this fact by incentivizing positive behaviors that support recovery through immediate, tangible financial rewards. In fact, CM is currently considered the gold standard treatment for stimulant use disorders, for which there is no FDA-approved pharmacological treatment.
In CM, patients receive financial incentives for achieving predefined treatment goals, such as reducing substance use, engaging in care, and abstaining from using substances. Providers verify these actions through negative blood, saliva, or urine samples, appointment attendance, video recordings, or other methods of confirmation, and the patient receives a monetary reward via reloadable debit or gift card, voucher, or other means (e.g., $20 for a negative urine sample). In some statewide CM programs, including Michigan’s ongoing pilot, patients can earn up to $599 over 24 weeks of participation.
In a groundbreaking study on stimulant use disorder conducted with the Veterans Health Administration (VHA), whose patients experience high rates of stimulant-related overdose deaths, Coughlin and colleagues provided the first real-world evidence that CM is associated with reduced all-cause mortality. Veterans who received CM were 41% less likely to die in the following year than those who did not — an effect comparable to treating an opioid-based SUD with buprenorphine, the most widely prescribed medication for opioid use disorder in the U.S.
Importantly, Coughlin’s work shows recent technological advances have made it possible to remotely confirm target behaviors and deliver incentives, as well as lessen transportation demands, reducing potential barriers to implementing and sustaining CM. She found remotely delivered CM was associated with improved rates of abstinence, reductions in use, and higher engagement in treatment among people with alcohol, tobacco, and other SUDs.
To improve the uptake and effectiveness of remotely delivered CM and other SUD treatments, Coughlin and team have explored using web- and mobile-based technologies to deliver tailored, strategically timed messages to deter substance use and promote ongoing engagement in CM and other interventions that encourage alternative, healthier behaviors. Her research shows these technologies are especially promising for alcohol, tobacco, and cannabis SUD care.
Coughlin found that among adults ages 17-24, motivational messages that discourage risky alcohol use may be most effective when delivered ahead of high-probability drinking days, such as Thursday, Friday and Saturday, and when someone is experiencing high levels of stress or hopefulness. Her research shows that among adolescents and young adults who use alcohol and cannabis, which are often used together, binge-drinking, and frequency of drinking and driving declined after only one month of digitally-delivered intervention messages.
At-risk alcohol use among adults, especially in rural areas, can sometimes go undertreated due to transportation barriers, healthcare and provider shortages, and cost. However, Coughlin found that over 98% of adults in rural areas participating in a behavioral economic mobile phone pilot program enjoyed participating in the trial, and approximately 70% reported the intervention influenced their future drinking. Her work shows that other factors may further enhance the effectiveness of remotely delivered behavioral economic interventions in rural communities, such as embedding themes into intervention messages related to the lived experiences and values of rural adults, including seasonal weather, kinship and family, outdoor activity, and religion.
For people who use tobacco, which is the leading cause of preventable death, disease, and disability in the U.S., Coughlin and team found among those using remotely delivered CM to quit, smoking in the last four hours and high stress levels were predictive of future smoking. In fact, her work shows those who received intervention messages aligned with personal reasons to not smoke like health, family and cost, especially during high-risk periods, were 7% more likely to remain engaged in treatment and submit a breath sample for CM verification than those who did not receive a message.
Unlike other SUDs, treating cannabis use disorder can be difficult because those who use cannabis often do not perceive it as harmful – in fact, they may even feel it provides certain health-related benefits – and the experienced harms are frequently not recognized as being linked to use. However, people who regularly use cannabis for recreational or medicinal purposes commonly report withdrawal symptoms when quitting. Given the challenges associated with treating cannabis misuse, Coughlin proposes using treatment models with low barriers to entry that are aligned with harm reduction goals, such as remotely delivered CM and other behavioral economics-based approaches. Crucially, she and her team found 82% of participants with cannabis use disorder in a telehealth pilot trial remained engaged throughout treatment, despite not being treatment-seeking at the start of the trial, leading to an average of 2.57 fewer days of cannabis use per month. This suggests remotely delivered behavioral economics-based treatments may be an effective option for reducing cannabis use.
Policy engagement and sustained impact
Coughlin uses her expertise as a researcher and clinical psychologist to inform addiction care policy and practice at the local, state, and national levels, contributing to the increased recognition and adoption of behavioral economics-based interventions, such as CM, as effective SUD treatments.
In 2024, Coughlin and team's findings on CM’s reduction in stimulant-based SUD mortality were shared with the Substance Abuse and Mental Health Services Administration (SAMHSA) to inform its upcoming advisory on addiction care. Starting in 2025, SAMHSA’s updated policy now allows grantees to offer $750 in annual CM incentives per patient, up from $75, removing a previously significant barrier to adoption. The mortality study was later recognized as a Top 10 Policy Breakthrough of 2025 by the Addiction Policy Forum.
To help advance CM adoption across the country, Coughlin encourages the use of Section 1115 Medicaid demonstration waivers, which allow Medicaid agencies to test innovative projects and treatments, to pilot CM for SUD care among state Medicaid populations. As of 2026, five states have been approved for a waiver (California, Delaware, Hawaii, Montana and Washington), and two are pending approval (Michigan and Rhode Island). Coughlin is also a lead facilitator of the National Contingency Management Community of Practice, a collaborative learning forum of researchers, treatment providers, implementers, training and technical assistance leaders, state agencies and other CM partners focused on supporting the adoption and sustainability of CM across the U.S.
In Michigan, Coughlin serves as a subject matter expert for the Michigan Department of Health and Human Services (MDHHS) to inform the state’s current CM efforts, known as Recovery Incentives, as well as its 1115 demonstration waiver application. In this role, she advises on the distribution of incentives, incentive caps, polysubstance engagement standards, single-substance target behaviors, and aligning with best practices from other CM programs across the country. She has presented her work on CM to other key stakeholders as well, including the Michigan Association of Health Plans, Tobacco-Free Michigan, SUD directors from across the state, and Medicaid Managed Care Quality leaders.
Coughlin also leads the Incentives2Quit initiative, a remote CM program for tobacco cessation, and contributes to tobacco cessation guidelines and policy both nationally and in Michigan. As a member of the National Comprehensive Cancer Network Smoking Cessation Clinical Practice Guideline Panel, she successfully supported the inclusion of CM as a recommended treatment option in the clinical practice smoking cessation guidelines for patients with cancer and cancer survivors. In Michigan, Coughlin served on the MDHHS Tobacco Section Wellness Committee and informed the state’s efforts to encourage behavioral health facilities to go tobacco-free. She recently served on the MDHHS Tobacco Control Section Strategic Planning Steering Committee, where she advised on statewide cessation efforts and youth tobacco and vaping policy.
Additionally, Coughlin’s work has been cited in numerous policy documents across the country, including in the states of Connecticut, Hawaii, Idaho, Indiana, Iowa, Michigan, Minnesota, Vermont, and Washington. At the federal level, her research has been referenced by the Agency for Healthcare Research and Quality and the Office of the Surgeon General, and internationally by the International Agency for Research on Cancer.
As co-director of MI-ACRE, Coughlin’s upcoming work will focus on establishing a network of addiction treatment clinics across Michigan to expand the populations and geographic areas able to participate in clinical trials and other efforts to improve addiction care. Her research will continue to examine the efficacy of behavioral economics-based treatments for cannabis use disorder and other SUDs.
More information about Lara Coughlin’s work can be found on her IHPI Profile and in Michigan Experts.
