IMPORTANCE Medication treatment for opioid use disorder (MOUD) is efficacious, but comorbid stimulant use and other behavioral health problems often undermine efficacy.OBJECTIVE To examine the association of contingency management, a behavioral intervention wherein patients receive material incentives contingent on objectively verified behavior change, with end-of-treatment outcomes for these comorbid behavioral problems.DATA SOURCES A systematic search of PubMed, Cochrane CENTRAL, Web of Science, and reference sections of articles from inception through May 5, 2020. The following search terms were used: vouchers OR contingency management OR financial incentives.STUDY SELECTION Prospective experimental studies of monetary-based contingency management among participants receiving MOUD. DATA EXTRACTION AND SYNTHESIS Following Preferred Reporting Items for SystematicReviews and Meta-analyses (PRISMA) reporting guideline, 3 independent investigators extracted data from included studies for a random-effects meta-analysis. MAIN OUTCOMES AND MEASURESPrimary outcome was the association of contingency management at end-of-treatment assessments with 6 clinical problems: stimulant use, polysubstance use, illicit opioid use, cigarette smoking, therapy attendance, and medication adherence. Random-effects meta-analysis models were used to compute weighted mean effect size estimates (Cohen d) and corresponding 95% CIs separately for each clinical problem and collapsing across the 3 categories assessing abstinence and the 2 assessing treatment adherence outcomes. RESULTSThe search identified 1443 reports of which 74 reports involving 10 444 unique adult participants met inclusion criteria for narrative review and 60 for inclusion in meta-analyses. Contingency management was associated with end-of-treatment outcomes for all 6 problems examined separately, with mean effect sizes for 4 of 6 in the medium-large range (stimulants, Cohen d = 0.70 [95% CI, 0.49-0.92]; cigarette use, Cohen d = 0.78 [95% CI, 0.43-1.14]; illicit opioid use, Cohen d = 0.58 [95% CI, 0.30-0.86]; medication adherence, Cohen d = 0.75 [95% CI, 0.30-1.21]), and 2 in the small-medium range (polysubstance use, Cohen d = 0.46 [95% CI, 0.30-0.62]; therapy attendance, d = 0.43 [95% CI, 0.22-0.65]). Collapsing across abstinence and adherence categories, contingency management was associated with medium effect sizes for abstinence (Cohen d = 0.58; 95% CI, 0.47-0.69) and treatment adherence (Cohen d = 0.62; 95% CI, 0.40-0.84) compared with controls. CONCLUSIONS AND RELEVANCE These results provide evidence supporting the use of contingency management in addressing key clinical problems among patients receiving MOUD, including the ongoing epidemic of comorbid psychomotor stimulant misuse. Policies facilitating integration of contingency management into community MOUD services are sorely needed.

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Early adverse experiences are important to consider in models of disordered eating. The results of this study highlight potential points of early prevention efforts, such as improving personal resources for those who experience early adversity, to help reduce the risk of body dissatisfaction and disordered eating in young women.

Objectives: This study examined whether self-focused and other-focused resiliency help explain how early family adversity relates to perceived stress, subjective health, and health behaviors in college women. Participants: Female students (n = 795) participated between October 2009 and May 2010. Methods: Participants completed self-report measures of early family adversity, selffocused (self-esteem, personal growth initiative) and other-focused (perceived social support, gratitude) resiliency, stress, subjective health, and health behaviors. Results: Using structural equation modeling, self-focused resiliency associated with less stress, better subjective health, more sleep, less smoking, and less weekend alcohol consumption. Other-focused resiliency associated with more exercise, greater stress, and more weekend alcohol consumption. Early family adversity was indirectly related to all health outcomes, except smoking, via self-focused and other-focused resiliency. Conclusions: Self-focused and other-focused resiliency represent plausible mechanisms through which early family adversity relates to stress and health in college women. This highlights areas for future research in disease prevention and management. Model postulates that early family adversity negatively impacts biological stress-response systems, emotion processing, and social competence, and these impairments subsequently make it difficult to cope with stress and manage health behaviors. 2 The broad full model also accounts for the potential influence of genetics and family social context, and studies have demonstrated support for the mechanisms theorized by the model to link early family adversity to stress and health behaviors known to contribute to poor health (for a review, see Repetti, Taylor, & Seeman, 2002). As such, the model provides a useful conceptual framework for considering the importance of psychosocial resiliency factors (see Figure 1), which is the focus of the present paper. However, with regard to psychosocial resiliency, the scope of resiliency factors accounted for is limited to emotion processing and social competence, 2 although studies have suggested that additional psychosocial factors may potentially link early family adversity to a variety of health problems. 3 As such, the purpose of this study is to examine whether broad psychosocial resiliency factors (i.e., "self-focused resiliency" and "other-focused resiliency") constitute plausible mechanisms linking early family adversity to health problems facing female college students. 4A theoretical review describing a taxonomy of psychosocial resiliency resources suggests that emotion processing and social competence may reflect just one dimension (i.e., behavioral and cognitive skills) of resources a person has available to them when they experience stress. focused (e.g., self-esteem 5,6 ) and other-focused resiliency (e.g., perceived social support 7-9 ) and health in adulthood, and that early family adversity may disrupt the development of these resources (e.g., self-esteem;...