Prize-based contingency management for the treatment of substance abusers: a meta-analysis

• Published in: Addiction (Abingdon, England) Vol. 109; no. 9; pp. 1426 - 1436
• Main Authors: Benishek, Lois A., Dugosh, Karen L., Kirby, Kim C., Matejkowski, Jason, Clements, Nicolle T., Seymour, Brittany L., Festinger, David S.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.09.2014; Blackwell
• Subjects: Abstinence; Addiction; Addictive behaviors; Adult and adolescent clinical studies; Awards; Awards and Prizes; Biological and medical sciences; Clinical outcomes; Confidence intervals; Contingency management; Desintoxication. Drug withdrawal; Drug Abuse; Drug addicts; Drug use; Drug Users - psychology; Humans; incentives; Management; Medical Research; Medical sciences; meta-analysis; Miscellaneous; Motivation; prize-based; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Social behaviour; Social control; Substance Abuse; Substance abuse treatment; substance use disorder; Substance-Related Disorders - psychology; Substance-Related Disorders - therapy; Systematic review; Treatments; Human; Incentive; Drug addiction; Poison withdrawal; Evidence-based practice; meta-analysis; substance use disorder; Substance abuse; Review; Evidence-based medicine; prize-based; Metaanalysis; incentives; Treatment; Addiction; Contingency management; substance abuse treatment; Drug of abuse; Reward
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/add.12589

Aim To review randomized controlled trials to assess efficacy of a prize‐based contingency management procedure in reducing substance use (where a drug‐free breath or urine sample provides a chance of winning a prize). Methods A meta‐analysis was conducted on papers published from January 2000 to February 2013 to determine the effect size of studies comparing prize‐based contingency management to a treatment‐as‐usual control condition (k = 19 studies). Parallel analyses evaluated the efficacy of both short‐ (k = nine studies) and long‐term outcomes (k = six studies) of prize‐based contingency management. Results The average end‐of‐treatment effect size (Cohen's d) was 0.46 [95% confidence interval (CI) = 0.37, 0.54]. This effect size decreased at the short‐term (≤3‐month) post‐intervention follow‐up to 0.33 (95% CI = 0.12, 0.54) and at the 6‐month follow‐up time‐point there was no detectable effect [d = −0.09 (95% CI = −0.28, 0.10)]. Conclusion Adding prize‐based contingency management to behavioral support for substance use disorders can increase short‐term abstinence, but the effect does not appear to persist to 6 months.