Patients with opioid use disorder (OUD) who receive monetary rewards for completing goals within a medication-assisted treatment program have better outcomes than those who do not, according to a systematic review and meta-analysis published Wednesday in JAMA Psychiatry.
“This systematic review and meta-analysis provides support for the efficacy of contingency management for addressing a wide range of substantive clinical problems common among people receiving [medication-assisted treatment for OUD], including the current crisis of comorbid stimulant use disorder,” wrote Hypatia A. Bolivar, Ph.D., of the University of Vermont and colleagues.
Contingency management involves giving patients tangible rewards, such as vouchers exchangeable for retail items, when they show evidence of meeting therapeutic targets (for instance, abstinence from illicit drug use). “Incentives work because they stimulate the same brain areas as the medications used in treatment,” co-author Stephen T. Higgins, Ph.D., director of the Vermont Center on Behavior and Health and a professor of psychiatry and psychological science at the University of Vermont, told Psychiatric News by email.
The researchers examined the impact of contingency management on patients who received medication-assisted treatment for OUD, including abstinence from psychomotor stimulants, illicit opioids, and/or cigarettes; medication adherence; and therapy attendance. They reviewed the results of 74 studies involving more than 10,000 adults who received medication-assisted therapy for OUD; 60 of these studies were included in the meta-analysis. (The average amount participants could earn in the contingency management programs studied ranged from about $10 to $15 a day.)
Key results included the following:
- When researchers combined data from all the trials examining abstinence, they found that contingency management was associated with significant improvements compared with other treatments. Higgins reported that 72% of the patients who participated in the programs had better end-of-treatment abstinence, compared with those who did not.
- Contingency management also resulted in significant improvements in therapy attendance and medication adherence. Higgins said that 73% of the patients had a better treatment outcome for attending therapy or adhering to the medication than those who did not participate in these programs.
- Eighteen of 22 studies reviewed reported significant increases in end-of-treatment abstinence from stimulants. Higgins noted that 76% of the patients had better abstinence from stimulants than those who did not participate in these programs.
- Four out of five studies found that contingency management was associated with increased abstinence from cigarette smoking.
“Contingency management is a highly effective intervention for what is coming to be known as the twin epidemics—use of opioids and psychomotor stimulants. Yet it is not currently used in most community clinics due to lack of reimbursement by the government,” Higgins said. “Advocate your state leaders, the health department, and medical directors at the Centers for Medicare and Medicaid Services on the need to use these evidence-based interventions.”
For related information, see the Psychiatric Services article “Implementation of Contingency Management at a Large VA Addiction Treatment Center.”
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Assistant Secretary for Mental Health and Substance Use to Speak at Mental Health Services Conference
Miriam Delphin-Rittmon, Ph.D., the newly appointed assistant secretary for mental health and substance use and administrator of the Substance Abuse and Mental Health Services Administration, will deliver the opening keynote address on Thursday, October 14, at APA’s virtual Mental Health Services Conference. Register today to hear Delphin-Ritton speak about how to increase access to care and how federal funds might be used in innovative ways to provide sustainable services that help our society’s most vulnerable populations to receive evidence-based care.