Summary of findings 4. Contingency management versus standard care for both severe mental illness and substance misuse.
| CONTINGENCY MANAGEMENT compared to STANDARD CARE for both severe mental illness and substance misuse | ||||||
| Patient or population: people with both severe mental illness and substance misuse Settings: community Intervention: Contingency Management Comparison: STANDARD CARE | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| STANDARD CARE | CONTINGENCY MANAGEMENT | |||||
| Leaving the study early: Lost to treatment Follow‐up: mean 3 months | 315 per 1000 | 487 per 1000 (355 to 664) | RR 1.55 (1.13 to 2.11) | 255 (2 studies) | ⊕⊕⊕⊝ moderate1,2 | |
| Adverse event: Death ‐ not measured | See comment | See comment | Not estimable | ‐ | See comment | None of the trials measured death as an outcome. |
| Substance use: Alcohol | See comment | See comment | Data were skewed and no between‐arm comparison were reported. | |||
| Substance use: Drug (non‐alcohol) Number with stimulant‐positive urine test Follow‐up: mean 6 months | 647 per 1000 | 537 per 1000 (421 to 686) | RR 0.83 (0.65 to 1.06) | 176 (1 study) | ⊕⊕⊝⊝ low1,3 | |
| Service use*: Number hospitalised Follow‐up: mean 6 months | 106 per 1000 | 22 per 1000 (5 to 98) | RR 0.21 (0.05 to 0.93) | 176 (1 study) | ⊕⊕⊝⊝ low1,4 | Predefinded outcome of Mental state data were skewed and unuseable. |
| Global state | See comment | See comment | Not estimable | ‐ | See comment | Neither trial measured Global state |
| Quality of life/life satisfaction | See comment | See comment | Not estimable | ‐ | See comment | Neither trial measured Quality of life |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
1 Risk of bias: Rated as SERIOUS: Blinding was not possible so performance bias was rated as an unclear risk of bias. Primary outcome in both trials was urinalysis so detection bias was unlikely, Attrition bias was an unclear risk and greater than 20% across groups in both trials. 2 Imprecision: We did not downgrade. The confidence interval is wide although it does not cross 1 indicating appreciable harm.
3 Impresion: Rated as SERIOUS: The event rate is low (less than 300 according to GRADE) and the confidence interval includes 1 and appreciable benefit. 4 Imprecision: Rated as SERIOUS: The event rate is very low and the confidence interval is wide.