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

Abstract

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.

Keywords: Contingency management; incentives; meta-analysis; prize-based; substance abuse treatment; substance use disorder.

© 2014 Society for the Study of Addiction.

Figures

Figure 1

Flow Diagram of Study Retrieval Process

Figure 2

End-of-Treatment Effect Sizes (d) with 95% Confidence Intervals

Figure 3

Short-term Follow-up Effect Sizes (d) with 95% Confidence Intervals

Figure 4

6-month Follow-up Effect Sizes (d) with 95% Confidence Intervals