Table 1.
Description of each included study and intervention, organised by drug target of CM intervention.
| Study, publication date, publishing journal and location carried out | Design and usual opiate substitution therapy treatment | Participants randomised pre and post intervention | Intervention procedure | CM Schedule, length of intervention and max reward | Additional treatments | Primary Outcome | Abstinence Criteria | Substance use post intervention | Substance use at longest follow up |
|---|---|---|---|---|---|---|---|---|---|
| Cocaine | |||||||||
| Epstein et al. (2003) | 2 × 2 factorial design. CM or no CM, and CBT or Social support | Rand − 193 | Urines collected every Mon, Wed and Fri, and vouchers administered dependent on condition | Escalating with reset and bonus for three consecutive negative samples | Individual counselling sessions focussing on cessation of all drugs | Number of drug negative urines | Benzo <300 ng/ml | Throughout intervention, BZE levels were lower in the CM-only and combination groups than in the other two groups. F(1, 185) = 15.94, p < 0.001 | No significant difference between any of the groups at 12 month follow up |
| Psychology of Addictive Behavior Baltimore, Maryland, USA | Meth., between 50 and 80 mg/day | Post − 147 | 12 Weeks | ||||||
| Max $1155 | |||||||||
| Katz et al., 2002a, Katz et al., 2002b | Rand − 40 | Multiple Each phase lasted 11 days | 50% reduction in Benzo. or Benzo <300 ng/ml | ||||||
| Experimental and Clinical Psychopharmacology Baltimore, Maryland, USA | Repeated measures − single, continuous, interrupted or no voucher meth. 100 mg/day | Post − Not reported | Urines collected Mon, Wed and Fri. Vouchers awarded dependent on condition (one large voucher, continuous or interrupted vouchers, or no voucher) | Max reward dependent on condition | Weekly individual and group counselling | Number of consecutive days cocaine abstinence | LDA | Mean abstinence duration was 2 days for no voucher, 3.2 days for single-voucher, and 4.9 and 4.8 days for continuous and interrupted voucher conditions, respectively, F(3, 117) = 7.3, p = < 0.001. | N/A |
| Kidorf et al. (1993) | Rand − 44 | Fixed schedule | Definition not reported | ||||||
| 7 Weeks | |||||||||
| Experimental and Clinical, Psychopharmacology Baltimore, Maryland, USA | CM or Yoked Control group. Ppt were accepted into the 2 years meth. treatment once the exp had done so Meth. 50 mg/day | Post − 43 | Urines collected Mon, Wed and Fri. The single reward was awarded after two consecutive weeks of cocaine abstinence which had to occur within the 7 week probationary period | Single reward of 2 years meth. treatment | Group and individual counselling at least once per week | Two consecutive weeks of cocaine abstinence | PNS | 50% of CM and 14% of control achieved 2 weeks of continuous cocaine abstinence. No significant difference was found between conditions for the number of negative urines returned | No significant difference between the two conditions was found for the proportion of cocaine negative urines submitted |
| Petry et al. (2007) | Rand − 76 | Fishbowl or voucher escalating with reset. | Not reported | ||||||
| Journal of Consulting and Clinical Psychology, Connecticut, USA | Prize based (fishbowl) or voucher based CM, or standard care control Meth. Mean dose between 78.4 and 83 mg/day dependent on condition | Post − 59 | Urines collected twice per week with an average of 4 days between submissions. Negative samples resulted in draws from the prize earn, or vouchers. | 12 weeks Max up to $300 and $585 respectively | Weekly individual and/or group counselling | Cocaine abstinence | LDA and PNS | Fishbowl CM ppt achieved significantly greater LDA than control ppt. Voucher CM ppt did not. | No significant difference between percentage of participants submitting negative samples in any condition at 9 months |
| Silverman et al. (1998) | Rand −59 | Escalating with reset, with bonuses in one condition. 12 weeks | Benzo. <300 ng/ml | ||||||
| Journal of Consulting and Clinical Psychology Baltimore, Maryland, USA | Three conditions, Escalating CM, Escalating CM with start bonus, and yoked control Meth. Mean dose 62 mg/day | Post − Average retention 10.3–11.3 weeks dependent on condition | Urines collected Mon, Wed and Fri. Vouchers dispensed after urines tested | Max reward $1950 without bonuses | Offered weekly individual counselling | Not reported | LDA | Both CM conditions achieved significantly longer durations of abstinence | Difference between CM groups and control remained significant at 8 weeks |
| Silverman et al. (1996) | Two conditions, escalating with reset CM and yoked control | Rand − 37 | Urines taken Mon, Wed and Fri. | Escalating with reset and bonus. | Benzo. <300 ng/ml | ||||
| 12 weeks | |||||||||
| Archives of General Psychiatry, Baltimore, Maryland, USA | Meth. 50 mg/day | Post − 89% of exp ppt and 83% of ctrl ppt retained for full 12 weeks | Vouchers given for abstinence | Max $1155 | Weekly individual counselling (45 min per week) | Not reported | LDA | Exp patients achieved significantly longer durations of sustained cocaine abstinence than ctrl ppt (F(1.35) = 13.5; p = <0.001) | No significant difference found between groups 4 weeks post intervention |
| Umbricht et al. (2014) | 2 × 2 Design. CM or Yoked control and Topiramate or placebo. | Rand − 171 | Escalating with reset. | Benzo. <300 ng/ml | |||||
| Drug and Alcohol Dependence, Baltimore, Maryland, USA | Meth. 100 mg/day | Post − 113 | Urines collected Mon, Wed and Fri. Vouchers awarded for abstinence | 31 weeks Max $1155 | Weekly individual and group counselling | Cocaine abstinence between weeks 9 and 20 | PNS and LDA | No significant difference found between any of the conditions | N/A |
| Vandrey et al. (2007) | Rand − 12 | Fixed, with a single voucher or cheque available in each condition. | Benzo. <300 ng/ml | ||||||
| Experimental and Clinical Psychopharmacology | 2 × 4 design − 2 types of reward type (voucher or cheque) and 4 types of reward magnitude ($0, $25, $50 or $100) Meth., dose not reported | Post − Not reported | Urines collected Mon, Wed and Fri. Rewards were provided for evidence of abstinence Mon to Wed, on the Thur | 16 weeks (two 8 week periods) Largest voucher value $100 | Group and individual counselling | Not reported | PNS | No main effect of incentive type. Planned comparisons found that high value cheques resulted in significantly greater abstinence than high value vouchers | N/A |
| Opiates | |||||||||
| Ling et al. (2013) | 4 conditions, 4 CM, CBT, CM + CBT and no behavioural treatment Control | Rand − 202 | Fishbowl with escalating draws. | Exact criteria not reported | |||||
| Addiction, Los Angeles, USA | Suboxone, variable dose | Post − 134 | Urines collected twice weekly, with escalating numbers of draws for vouchers dependent on drug free urines | 16 weeks Max initially $2196, later reduced to $14600 | Counselling | Proportion of opiate negative urines | PNS | Mean number of consecutive opioid-negative UA results did not differ significantly by group. | Same results 52 week follow up as post treatment |
| Preston et al. (2000) | Rand − 120 | Escalating with reset. | <300 ng/ml opiates | ||||||
| 8 weeks | |||||||||
| Archives of General Psychiatry, Baltimore, Maryland, USA | 4 Conditions: CM, Increased meth. with non contingent vouchers, CM + meth. increase, usual treatment control with non contingent vouchers Meth. dose not reported | Post − 112 | Urines collected Mon, Wed and Fri. Vouchers administered for evidence of abstinence | Max $554 | Weekly individual counselling | Opiate negative urine samples | PNS and LDA | LDA significantly increased with contingent vouchers (F(1116) = 10.02, p = 0.002) | N/A |
| Cocaine and Opiates | |||||||||
| Chutuape et al. (2000) | Rand − 53 | Escalating with reset. | |||||||
| Drug and Alcohol Dependence, Baltimore, Maryland, USA | 3 conditions: CM with weekly or monthly urine testing, and a control where take home meth. was awarded randomly Meth. 60 mg/day | Post − 43 | Urines collected Mon, Wed and Fri. One urine randomly selected either weekly or monthly dependent on condition to decide whether vouchers awarded | 28 weeks Max reward was take home doses for all weeks | Weekly individual and group counselling sessions | Not reported | Not reported | The mean LDA was 10.5 (SD 8.9), 8.4 (SD 8.5), and 5.4 (SD 7) weeks for the Weekly, Monthly, and Random Drawings groups, respectively (F(2.52) 1.9, PB0.16). | N/A |
| Epstein et al. (2009) | Rand − 252 | Escalating with reset. | <300 ng/ml for both opiates and cocaine | ||||||
| Drug Alcohol Dependence, Baltimore, Maryland, USA | 3 × 2 dose by contingency design − meth. dose of either 70 mg or 100 mg and yoked control, CM for cocaine or split CM for cocaine and opiates | Post − 23% of ppt dropped out before the end of the intervention | Urines collected Mon, Wed and Fri. Vouchers were awarded for abstinence from cocaine and opiates either together or separately dependent on condition | 12 weeks Max not reported | Weekly individual counselling | Percentages of urine specimens negative for heroin, cocaine, and both simultaneously | PNS and LDA | Main effect of contingency on cocaine-negative urines, (F(2244) = 7.36, p = 0.0008) and on urines simultaneously negative for opiates and cocaine, (F(2244) = 3.61, p = 0.0285) but not in opiate-negative urines, (F(2244) = 2.51, p = 0.0830) | N/A |
| Groß et al. (2006) | Three conditions: CM vouchers, Reduction in medication, and standard treatment control | Rand − 60 | Escalating with reset and bonus. | <300 ng/ml of cocaine or opiates | |||||
| Experimental and Clinical Psychopharmacology, Vermont, USA | Bup, maintained on either 4 mg/70 kg or 8 mg/70 kg for the duration of the study | Post − 45 | Urines collected Mon, Wed and Fri. Dependent on condition, ppt either earned points, or did not have their bup dose decreased on evidence of abstinence | 12 weeks Max $269 | Behavioural drug counselling | Mean duration of continuous abstinence, total number of weeks abstinent (non-continuous), and number of missing visits. | LDA | Contingent medication ppt achieved significantly greater durations of continuous abstinence (M = 5.9 weeks, SD = 4.6) than ppt in the voucher group (M = 2.9 weeks, SD = 3.3; Fisher’s LSD, p=0.05). | N/A |
| Katz et al. (2002a,b) | Two conditions, CM or Standard care | Rand − 52 | <300 ng/ml for both opiates and cocaine | ||||||
| Experimental and Clinical Psychopharmacology, Baltimore, Maryland, USA | Meth. 100 mg/day | Post − Mean 35.9 days (of 180) in treatment | Urines collected three times per week and vouchers administered for negative samples | Escalating with reset and bonus 12 weeks Max $1,087.50 | Weekly individual cognitive behavioural counselling | Not reported | LDA and PNS | No statistically significant condition effects found | N/A |
| Petry et al. (2002) | CM or standared treatment | Rand − 42 | Fishbowl, escalating draws. | Not reported | |||||
| Journal of Consulting and Clinical Psychology, Connecticut, USA | Meth. Average 69 or 70 mg/day in standard treatment and CM | Post − 39 | Urines collected Mon, Wed and Fri. Ppt received on draw for abstinence from either cocaine or opiates, and four for abstinence from both. Continuous weekly abstinence earned bonus draws | 12 weeks Max number of draws dependent on abstinence from different drugs | Monthly individual counselling | Weeks of continuous abstinence from both opioids and cocaine | LDA | There were significant group difference in the percentage of urine samples negative for both drugs (F(1, 40) = 4.01, p = 0.05 | The percentage of urine samples negative for both opioids and cocaine was higher in exp than ctrl ppt (U = 112.0, p=0.05.) at 6 month follow up |
| Schottenfeld et al. (2005) | Rand − 162 | Escalating with reset. | <300 ng/ml for both opiates and cocaine | ||||||
| The American Journal of Psychiatry, USA | 2 × 2 design: meth. or buprenorphine and CM or performance feedback Maximum daily meth. dose of 85 mg or bup. dose of 16 mg | Post − Cumulative proportion: meth. + CM − 0.6, meth. + performance feedback − 0.75, Bup + CM − 0.45, Bup + Performance feedback − 0.5 | Urines collected Mon, Wed and Fri and vouchers administered for evidence of abstinence | 24 week Max $1033.50 | Individual counselling twice weekly for the first 12 weeks and weekly for the last 12 | Maximum number consecutive weeks of abstinence and proportion of drug-free urine tests | LDA | meth. ppt achieved significantly longer periods of abstinence than bup. There were no significant effects of CM (F = 0.09, df = 1, 158, p = 0.76) and no significant interaction between medication and CM (F = 0.10, df = 1, 158, p = 0.75) | N/A |
| Tobacco | |||||||||
| Dunn et al. (2010) | Rand − 40 | Escalating with reset 90 days | |||||||
| Experimental and Clinical Psychopharmacology Vermont, USA | Two conditions: CM and non contingent voucher Meth. 107.6 ± 8.8 mg/day or Bup. 14.9 ± 1.3 mg/day | Post − 25 | Biochemical verification taken everyday with vouchers for abstinence delivered daily. Numerous bonus's available for abstinence at certain points | Max $362.50 | None reported | Percentage of biochemical samples meeting abstinence criteria | Abstinence defined as breath CO ≤ 6 ppm during days 1–5 and a urine cotinine ≤ 80 ng/ml on Days 6–14 PNS and LDA | Exp. Ppt submitted significantly more negative samples than ctrl. Ppt (t (30.1) = 3.24, p < 0.01) | No significant difference between the two conditions at any follow up |
| Poly substance use | |||||||||
| Chutuape et al. (1999) | Two conditions: CM and usual care control | Rand − 14 | <200 ng/ml for meth., opiates, cocaine and benzodiazepines | ||||||
| Drug and Alcohol Dependence, Baltimore, Maryland, USA | Meth. 71 mg/day or 77 mg/day in CM and standard care conditions | Post − 12 | Urines collected Mon, Wed and Fri. Vouchers or take homes administered for evidence of abstinence dependent on ppt choice | Fixed. 12 weeks Max $900 or three take homes per week dependent on ppt choice | Twice-weekly counselling sessions (one individual and one group session) | Number of drug free urines | LDA | mean LDA for exp ppt was 8.4 and 1 week for ctrl ppt (t(8) = 5.9, p = <0.001.) | 5 ppt relapsed after the CM intervention. ended, generally within the first week |
| Downey et al. (2000) | Two conditions: CM and Yoked control | Rand − 41 | Urines taken Mon, Wed and Fri. | Escalating with reset and bonus. | <300 ng/ml for all drugs other than phencyclidine which was <25 ng/ml | ||||
| Experimental and Clinical Psychopharmacology, USA | Mixed Bup. Naloxone tablets. Dose not reported | Post − 21 | Vouchers administered for evidence of abstinence | 12 weeks Max not reported | Weekly cognitive behavioural substance abuse therapy | Not reported | LDA | No sig difference between the two groups on% drug free urines, LDA or total abstinence for heroin, cocaine or poly drug use during the voucher phase | N/A |
| Kidorf et al. (1996) | Rand − 16 | Fixed with negative consequences for drug positive samples. | |||||||
| Behavior Therapy, Baltimore, Maryland, USA | Two conditions: CM and usual care control Meth. 60 mg/day | Post − 14 | Urines collected Twice per week and take homes administered for evidence of abstinence. Samples positive for drugs resulted in meth. being administered in a split dose | 2 month cross over Max 2 take homes per week | Weekly individual counselling | Percentage of drug free urines | Breath alcohol < 0.5, other drug cut-offs not reported PNS | A condition main effect was found, (F(2, 30) = 4.43, p = < 0.05.) Patients submitted more drug-free urines when exposed to exp (M = 29%; SE = 9.0) than ctrl (M = 9%; SE = 3.0) | N/A |
| Peirce et al. (2006) | Rand − 388 | Fishbowl, escalating with reset. | Not reported | ||||||
| Archives of General Psychiatry USA | Two conditions: CM and usual care control Meth. Doeses ranging between 67.9 mg/day to 108 mg/day dependent on recruitment centre | Post − 67.1% of exp ppt and 64.8% ctrl ppt retained | Urines collected twice per week and prize draws allowed for evidence of abstinence | 12 weeks Max 204 draws, resulting in a maximum of approx. $400 in prizes, plus one guaranteed $20 prize. | Individual and group consoling. Frequency ranged from 3 times per week to once per month | Not reported | LDA | Exp ppt were significantly more likely to submit stimulant- and alcohol-negative samples than were ctrl ppt (OR, 1.98; 95% CI, 1.42-2.77; missing samples coded as missing) | No group differences in percentage of submitted samples negative for stimulants and alcohol (χ2 = 0.08, P=0.78). |
| Petry et al. (2015) | Rand − 240 | Escalating with reset for either fishbowl draws or vouchers dependent on condition. | Not reported | ||||||
| Journal of Consulting and Clinical Psychology, USA | Four conditions: $300 prize CM, $900 prize CM, $900 voucher CM and usual care control Meth. Doses ranging between 77 mg/day and 85.4 mg/day | Post − Not reported | Urines taken at least twice a week with at least 2 days between tests. Abstinence resulted in either fishbowl draws or vouchers | 12 weeks Max either $300 or 900$ | Weekly group counselling | LDA and proportion of samples submitted negative for cocaine and alcohol | PNS and LDA | The longest duration of abstinence and proportion of samples testing negative were significantly greater in each of the three CM conditions relative to usual care (F(3236) = 3.39, p = 0.02 and F(3236) = 3.94, p=0.009 respectively) | At the 12-month follow-up, 113 of 225 (50.2%) patients submitted negative samples |
Abbreviations – Rand- Randomised to conditions, Post- Post intervention, Exp – Experimental condition(s), Ctrl – Control condition, CM – Contingency Management, TLFB – Time Line Follow Back, LDA – longest duration of abstinence, PNS – percentage of negative samples, Meth. – methadone, Bup. – buprenorphine, Pbo. – placebo, ppt – participants, Benzo – benzoylecgonine, OST – Opiate substitution therapy.