Contingency management to reduce stimulant use
Summary of the evidence
Contingency management (CM) involves participants receiving something of value such as a gift card, voucher or chance to win a prize as a reward for the achievement of a specific and measurable desired behaviour, most commonly a negative urine drug test for stimulants when implemented for the treatment of stimulant use disorder.
CM alone was found in a systematic review of reviews (Ronsley et al., 2020, 29 systematic reviews examining eleven intervention modalities) to be effective in improving:
- abstinence at 12 weeks (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.62, 3.24),
- abstinence at the end of treatment (OR 2.22, 95% CI 1.59, 3.10),
- dropout at 12 weeks (OR 1.39, 95% CI 1.09, 1.78),
- and dropout at the end of treatment (OR 1.41, 95% CI 1.10, 1.82).
However the effect was not sustained at longest follow up (OR 1.10, 95% CI 0.83, 1.46).
Another more recent systematic review with meta-analysis (Bentzley et al., 2021) statistically compared all the different treatment options (157 studies comprising 402 treatment groups and 15 842 participants) looking for the interventions associated with an objective reductions in cocaine use among adults. Excluding other therapies, the largest treatment groups across all studies were psychotherapy (mean [SD] number of participants, 40.04 [36.88]) and contingency management programs (mean [SD] number of participants, 37.51 [25.51]). The analysis found that:
- only contingency management programs were significantly associated with an increased likelihood of having a negative test result for the presence of cocaine (OR, 2.13; 95% CI, 1.62-2.80), and this association remained significant in all sensitivity analyses.
A systematic review without meta-analysis (Hayley et al., 2020) described the broad benefits of contingency management, including greater drug abstinence, higher utilization of other treatments and medical services, and reductions in risky sexual behaviour specifically for methamphetamine users.
Another systematic review without meta-analysis (AshaRani et al., 2020) confirmed that CM interventions among all the behavioural interventions consistently showed benefits (reduced drug use, better treatment retention, reduction in psychiatric symptoms and better quality of life) during the treatment period of METH use; however, the sustainability of the effect, post-intervention, is not well-studied. Moreover they found that although CM and CBT, both demonstrated positive outcomes individually, no clear synergism was observed when CM interventions were combined together with CBT.