Contingency management to improve treatment outcomes in opioid users

A recent systematic review with meta-analysis (Bolivar et al., 2021, RCT= 74, N=10 444) found contingency management for patietns receiving medication for opioid use disorder to have:

• medium-large effect size for abstinence from stimulants, Cohen d = 0.70 [95% CI, 0.49-0.92]; cigarette use, Cohen d = 0.78 [95% CI, 0.43-1.14]; illicit opioid use, Cohen d = 0.58 [95% CI, 0.30-0.86] and improved medication adherence, Cohen d = 0.75 [95% CI, 0.30-1.21]),
• small-medium effect size for increased absitnence from polysubstance use, Cohen d = 0.46 [95% CI, 0.30-0.62] and improved therapy attendance, d = 0.43 [95% CI, 0.22-0.65]).
• Collapsing across abstinence and adherence categories, contingency management was associated with medium effect sizes for abstinence (Cohen d = 0.58; 95% CI, 0.47-0.69) and treatment adherence (Cohen d = 0.62; 95% CI, 0.40-0.84) compared with controls.

Contingency management was found in a systematic review (EMCDDA 2016, studies = 20, N=1 676) to be effective in:

• helping opioid users in substitution treatment to reduce cocaine use (10 out of 13 studies reported statistically significant results in favour of CM)
• helping opioid users in substitution treatment to improve cocaine abstinence (8 out of 8 studies reported statistically significant results in favour of CM)
• helping opioid users in detoxification to improve retention in treatment (2 out of 3 studies reported statistically significant results in favour of CM) as well as opioids and cocaine abstinence (7 out of 10 studies reported statistically significant results in favour of CM)