Contingency management for mono-substance use disorders: Systematic review and assessment of predicted versus obtained effects

Contingency management is incredibly successful as substance use disorder treatment and is most effective when targeting mono-drug use. In fact, there is evidence. the effects of contingency management exceed predictions based on the value of the incentives delivered for mono-drug abstinence. In this systematic review, we examine common variations of contingency management interventions applied to a single problem substance to determine what factors may contribute to the larger effect. Our results show that contingency management produced moderate to large effect sizes when single drugs were targeted, with stable effects over time. We also found that interventions targeting cocaine abstinence overwhelmingly outperformed their predicted effect, whereas interventions for smoking cessation did not. Thus, incentives alone may not account for the success of contingency management, at least when applied to stimulant use disorder. We propose other potential sources of the effect, including social reinforcement and the specific parameters of the reinforcement schedule.