The United States is facing a profoundly damaging crisis related to a substance use epidemic. Contingency management (CM) in tandem with standard therapies for substance use disorder (SUD) is a practical, yet largely unembraced, therapy for which an ethical imperative exists for its adoption. The efficacy of CM in promoting sustained abstinence across a wide array of SUDs has been well demonstrated. The upfront and maintenance costs of widely implementing a CM-based SUD treatment strategy will produce a substantial positive return on investment. The most potent barriers to widespread adoption of the addition of CM to SUD treatment strategies is rooted more in ethical objection to implementation than in pragmatic obstacles. Yet the foundation of these ethical objections lack sufficient force to render them dispositive. A review of the efficacy of CM, its cost/benefit ratio, and the tenuous nature of ethical objections will be explored. CM should be widely implemented as a more clinically efficacious and cost-efficient strategy for addressing the drug use crisis compared to current approaches. In addition, this therapy method, possibly the most successful adjunct to standard therapy to treat SUD, will aid the country as a whole in terms of societal benefits associated with effectively treating people struggling with substance misuse
