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Stepped care escalates intensity when objective measures show insufficient response. Here, persistent heavy-use days and evening cravings indicate the need to enrich the plan. Contingency management ties immediate reinforcement to verifiable behaviors (attendance, negative tests, completion of skill tasks), increasing adherence. Just-in-time supports (scheduled evening check-ins, automated prompts) improve coverage during high-risk windows. A targeted coping module (stimulus control, urge surfing, refusal scripts, alternative routines) addresses the specific antecedents driving use. Waiting passively (A) risks continued harm. Punitive discharge (C) ignores data-driven iteration and erodes alliance. Education-only groups (D) are low intensity and rarely change behavior without skills practice and reinforcement. MAC competencies emphasize measurement-based adjustments, collaborative problem solving, and documentation of rationale and outcomes. If pharmacotherapy is acceptable, coordinate with prescribers; otherwise, double down on skill acquisition and reinforcement to produce measurable improvements.