Contingency Management for Drug Use Disorders: Meta-Analysis and Application of Tolin's Criteria

Several professional organizations and federal agencies recommend contingency management (CM) as an empirically supported treatment for drug use disorder. However, the release of the "Tolin criteria" warrants an updated recommendation. Using the Tolin criteria, five meta-analyses (84 studies, 11,000 participants) were reviewed. Two meta-analyses were rated moderate quality, and three were rated low or critically low quality. Comparator conditions included active treatment, placebo, treatment as usual, and no treatment. The primary outcome was abstinence. Considering only the moderate quality meta-analyses, the effect of CM versus control on posttreatment abstinence was d = 0.54 [0.43, 0.64] and follow-up abstinence was d = 0.08 [0.00, 0.16]. A "strong" recommendation was provided for CM as an empirically supported treatment for drug use disorder. Public Health Significance Statement A systematic review and meta-analysis indicated that contingency management (sometimes referred to as motivational or financial incentives), compared with active treatment, placebo, treatment as usual, and inactive control conditions, produced clinically meaningful and statistically significant improvements in abstinence at posttreatment, as well as small effects on abstinence at follow-up. Contingency management should be made accessible to all individuals seeking treatment for drug use disorders.