Contingency management for substance use disorders: Efficacy, implementation, and training
- Maxine Stitzer, PhD
Maxine Stitzer, PhD
- Professor of Psychiatry and Behavioral Sciences
- Johns Hopkins Bayview Medical Center
- Colin S Cunningham, PhD
Colin S Cunningham, PhD
- Postdoctoral Fellow, Department of Psychiatry and Behavioral Sciences
- Johns Hopkins School of Medicine
Contingency management and other psychosocial interventions have a substantial role in the treatment of patients with substance use disorders (SUDs), particularly those for which pharmacotherapy is unavailable or only partially effective. Contingency management is typically delivered as an augmentation to psychosocial treatment such as SUD counseling or psychotherapy.
Contingency management uses incentives to encourage treatment attendance and/or abstinence from alcohol/drug use. Contingency management interventions can be customized to some extent to address patient preferences or program needs, such as the resources available for the intervention.
This topic describes the efficacy, implementation, and training for contingency management. The theoretical foundation, indications, assessment, and components of contingency management for SUD are discussed separately. Other SUD treatments, including those for specific substances, are also discussed separately. (See "Contingency management for substance use disorders: Theoretical foundation, principles, assessment, and components" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Treatment of cannabis use disorder" and "Psychosocial interventions for stimulant use disorder in adults" and "Pharmacotherapy for smoking cessation in adults" and "Behavioral approaches to smoking cessation" and "Continuing care for addiction: Indications, features, and efficacy" and "Continuing care for addiction: Implementation".)
Clinical trials generally support the efficacy of contingency management for enhancing treatment attendance and increasing abstinence outcomes in treatment of substance use disorders (SUDs).
Treatment attendance — A review of 16 clinical trials of contingency management targeting attendance concluded that findings were mixed but generally supportive of efficacy .
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- Treatment attendance
- Drug abstinence
- - Stimulants
- - Cannabis
- - Alcohol
- - Tobacco smoking
- SUBGROUP CONSIDERATIONS
- Dual diagnosis
- Pregnant smokers
- Voucher versus intermittent prize reinforcement
- Escalating versus fixed schedules
- Behavioral therapy platform
- Treatment tailoring
- - Remitted versus active drug users
- Multple drugs
- Treatment duration
- SUMMARY AND RECOMMENDATIONS