Aaron Barbour grew up in southeast Missouri and said methamphetamine has been a big problem in the region since he was a kid. He said at just 15 years old, he was peer pressured into trying the drug.
“My life was chaos from day to day. I didn't know what I was doing one day to the next,” Barbour said. “I had no structure in my life. I had no routine.”
This is the second of two stories focused on the current status of methamphetamine and stimulant use disorder treatment in Missouri.
He said what followed was nearly 20 years of active polysubstance use and addiction, which means he was using methamphetamine alongside other illicit substances.
“I was lost … I was miserable, and what I was doing to deal with my problems wasn't working,” Barbour said. “And I only saw one way out, and that was sobriety, and I made a conscious decision to get sober, and I haven't looked back since.”
"So, contingency management is an evidence-based program that encourages clients and rewards them immediately for those negative drug screens."Clinic Manager Myranda Odom, FFC Behavioral Health - Poplar Bluff
Barbour said he went to rehab multiple times before it truly “stuck,” but now he’s celebrating seven years of sobriety, has gone back to school and is working as a substance use disorder (SUD) counselor at FCC Behavioral Health, which has treatment centers all throughout southeast Missouri and the Bootheel.
Clinic Manager Myranda Odom said they have a lot of patients for methamphetamine use disorder. This is a specific form of stimulant use disorder where the addictive substance is meth.
She said she believes 70-75% of their clients are being treated for stimulant and/or meth use, though they may be using more than one drug.
“They can come from any walk of life,” Odom said. “We definitely have a population of homelessness [people]. We also have some clients that seemingly, you wouldn't think had a problem in the world, you know? Some of them have a home, have had a very good career.”
Christine Smith, the director of prevention and crisis services for the Missouri Department of Mental Health, said while the southeast part of the state does have a disproportionate rate of meth use compared to other regions – it is a problem across the whole state.
From August 2025 to July 2026, 29% of the people served in substance use disorder programs across the state reported methamphetamine as the primary substance at admission. Second only to alcohol.
Additionally, the state reported that 57% of the people admitted for methamphetamine use were treated for polysubstance use.
“There is a health concern. I would also say family relationships, friendships may suffer. Your work life may be impacted with use,” Smith said. “Just really any part of your life that any other substance would impact.”
She said while there are plentiful medication-based treatments for other substances, such as alcohol and opioids, there are limited options for evidence-based treatment when it comes to helping those with stimulant and methamphetamine use disorders.
The best option, Smith said, is a behavioral treatment model called contingency management.
What is contingency management?
Essentially, the program works by incentivizing and rewarding good, positive behavior choices consistent with recovery, be that attending group therapy sessions or testing negative for meth on regular drug screens.
Dr. Jeremiah Weinstock is a licensed psychologist who chairs the Department of Psychology at St. Louis University. He’s also an addiction treatment expert and was hired by DMH as a consultant to help disseminate and implement contingency management programs across the state
“We have all been exposed to a version of contingency management because all it is is positive reinforcement,” Dr. Weinstock said. “Corporate America uses positive reinforcement all the time with the Starbucks frequent reward card or the Panera reward card or your frequent flyer miles or your Discover card that gives 5% cash back … and so, what we're doing is providing positive reinforcement for behaviors.”
Dr. Weinstock said contingency management is a 12-week program that is designed to disrupt the cycle of drug use and promote a period of abstinence.
This period of time, he said, allows a patient to find some stability and begin rebuilding their lives — perhaps getting a job, finding housing or reuniting with family and other social supports.
“And what that does for me, as a therapist, then is gives me a window of opportunity to get in there and do the skills training that I want to do to help you build support … because we know that the keys to entering into recovery are social support around this change, right?” Dr. Weinstock said. “And it's a predictor of long-term success, you know, building social support, building some coping skills for when you do get that urge.”
He added what while the physical dependency of meth use may look different than opioid substance use disorder, it can still be a hard cycle to break without help and encouragement.
When a stimulant, such as methamphetamine or cocaine, are used, the brain is flooded with incredible amounts of dopamine, a chemical related to pleasure. So, Dr. Weinstock said when the brain is not receiving that “pleasurable rush” that comes from use, it can lead to what’s called rebound depression.
“That's the healing that has to go on in their brain, and that's only a product of time, and it has to be through a period of abstinence,” Dr. Weinstock said.
Back in Poplar Bluff, Myranda Odom said their contingency management program looks fairly simple. First, they do an assessment of the individual and see what other types of integrated co-occurring therapies they might need, such as treatment for depression, anxiety or other mental health conditions.
Then, they pair them with a SUD counselor, such as Aaron Barbour, who they will meet with weekly.
Finally, they begin the 12-week contingency management. Twice a week, clients come in and do a urine drug screen and if it is negative for meth, they get to draw a prize.
These prizes — printed on bright pink slips of paper — range from simple words of encouragement, such as “Good job,” to electronic gift cards in varying amounts.
“A small prize is $5. Large prize is $20, and then there's one jumbo prize for $100, and we just had someone draw that last week,” Barbour said.
As the weeks go on, the individuals can earn more and more chances to draw prizes by meeting other treatment goals and continuing to have negative drug screens.
“I've had several say that might be the only way I eat this week,” Odom said. “That could help me with gas, you know? That could make sure I get to my next appointment.”
She added that transportation is a huge challenge for clients in southwest Missouri, so they have begun offering some limited, virtual options to those enrolled in the contingency management program.
For this, they are allowed to do some of their drug screens via self-swab while their SUD counselor carefully monitors to ensure it’s done correctly.
This close monitoring of drug screens is just one of the safeguards in place to ensure that contingency management is not being misused. The other, in Missouri, is that participants can only earn up to $599 in a year.
Implementation challenges
Dr. Weinstock said despite there being no medications that work for stimulant and methamphetamine use disorders and contingency management being the best treatment option available, there are still only four clinics in the state that are currently offering it: the one in Poplar Bluff, one in Joplin, one in Kansas City and one in St. Louis.
“We haven't gotten good yet at disseminating contingency management into our treatment systems,” Dr. Weinstock said, “We're still struggling to roll this treatment out and make it widely available.”
Some of this could be due to continued stigma around meth use or concerns about “rewarding” those with substance use disorders.
But leading health organizations, such as the American Society of Addiction Medicine and the federal Substance Abuse and Mental Health Services Administration (SAMSHA) have put out guidance and recommendations for implementing contingency management programs.
So, what is holding clinicians back?
Sydney Cleavenger, a third-year law student at St. Louis University's School of Law, has been looking into the issue, and said it appears to be a fear of violating the federal government’s Anti-Kickback Statute.
This law broadly makes it illegal for medical providers to offer gifts and incentives to clients who use their services.
Cleavenger said the law was originally passed in the 1970s to prevent fraud within federal healthcare programs, such as Medicare and Medicaid.
“It pretty much makes it illegal and criminalizes any providers who do provide remuneration for clients to use their services or for referrals, and a lot of providers have been very scared about that,” Cleavenger said. “There was actually a case where the providers were actually arrested and fined… I mean it's up to 10 years and, I think, $100,000 in fines, sometimes both, for violating the Anti-Kickback Statute, and it's been very scary.”
She said last year, SAMSHA increased the monetary cap on SAMSHA-funded contingency management incentives to $750 per patient, per year.
And, in the past, the US Department of Health & Senior Service’s Office of the Inspector General has issued advisory opinions that permit individual providers to offer a contingency management program.
According to the Missouri Department of Mental Health, the gender breakdown of those seeking methamphetamine use disorder treatment between August 2025 and July 2026 was 45% Female — 55% Male.
But, she emphasized, without a broader, “safe harbor” exemption for contingency management programs, many providers have simply been too anxious to offer the treatment.
“We need to add a few words, just a few words,” Cleavenger said, “and it would allow providers to provide contingency management.”
Chris Jones, the director of the Center for Substance Abuse Prevention at SAMSHA, said the organization is actively working with state and local organizations to try and build a system of care that meets the needs of those with stimulant and methamphetamine use disorders.
He said that in the future he wants to see treatment options expand for this population, be it through contingency management programs or an eventual medication-intervention for the disorder.
But for now, he said he wants people with methamphetamine use disorders to know that there is help, even if it’s not contingency-based.
“It is treatable. I think that's really important for people to know that people do recover,” Jones said. “It is not a sentence to the criminal justice setting or you're going to die from your use... There is a better future for people who are struggling.”
If you or someone you know is struggling with substance use disorder and wants help, you can search for treatment providers in your area at https://findtreatment.gov/.
