A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies

Abstract

This review of contingency management (CM; the behavior-modification method of providing reinforcement in exchange for objective evidence of a desired behavior) for the treatment of substance-use disorders (SUDs) begins by describing the origins of CM and how it has come to be most commonly used during the treatment of SUDs. Our core objective is to review, describe, and discuss three ongoing critical advancements in CM. We review key emerging areas wherein CM will likely have an impact. In total, we qualitatively reviewed 31 studies in a systematic fashion after searching PubMed and Google Scholar. We then describe and highlight CM investigations across three broad themes: adapting CM for underserved populations, CM with experimental technologies, and optimizing CM for personalized interventions. Technological innovations that allow for mobile delivery of reinforcers in exchange for objective evidence of a desired behavior will likely expand the possible applications of CM throughout the SUD-treatment domain and into therapeutically related areas (eg, serious mental illness). When this mobile technology is coupled with new, easy-to-utilize biomarkers, the adaptation for individual goal setting and delivery of CM-based SUD treatment in hard-to-reach places (eg, rural locations) can have a sustained impact on communities most affected by these disorders. In conclusion, there is still much to be done, not only technologically but also in convincing policy makers to adopt this well-established, cost-effective, and evidence-based method of behavior modification.

“Setting people up for success and then failure” – health care and service providers’ experiences of using prize-based contingency management

“…Over the last 50 years, there has been a growing interest in and use of contingency management (CM) for people who use substances [1][2][3][4][5]. CM is rooted in operant conditioning (also known as instrumental conditioning) and based on the general principle that behaviors, such as substance use, are controlled by their consequences [6].…”

“…To modify such behaviors, one has to modify the consequences using positive or negative reinforcements [3]. When used with people who use substances, CM is typically designed to provide positive reinforcements in exchange for desired processes (e.g., attending a clinic appointment), behaviors (e.g., maintaining abstinence), and outcomes (e.g., negative urine drug screening) [1,3,4,7].…”

“…CM is rooted in operant conditioning (also known as instrumental conditioning) and based on the general principle that behaviors, such as substance use, are controlled by their consequences [ 6 ]. To modify such behaviors, one has to modify the consequences using positive or negative reinforcements [ 3 ]. When used with people who use substances, CM is typically designed to provide positive reinforcements in exchange for desired processes (e.g., attending a clinic appointment), behaviors (e.g., maintaining abstinence), and outcomes (e.g., negative urine drug screening) [ 1 , 3 , 4 , 7 ].…”

Adaptation of contingency management for stimulant use disorder during the COVID-19 pandemic

“…Given the broad applicability of CM, including promoting healthy behaviors (Landovitz, Fletcher, Shoptaw, & Reback, 2015;McPherson et al, 2018;Rash, Stitzer, & Weinstock, 2017;Shoptaw et al, 2017), we suggest expanding its use during the COVID-19 pandemic.…”

“…Psychosocial interventions are first line treatment for stimulant use disorders, with pharmacological interventions being largely ineffective ( Chan et al, 2019 ; De Crescenzo et al, 2018 ). There is strong evidence that CM is an effective intervention for stimulant use disorders ( Carrico et al, 2018 ; De Crescenzo et al, 2018 ; Higgins, Wong, Badger, Ogden, & Dantona, 2000 ; McDonell et al, 2013 ; McPherson et al, 2018 ; Petry, Alessi, Olmstead, Rash, & Zajac, 2017 ; Rawson et al, 2006 ; Shoptaw et al, 2005 ; Shoptaw, Landovitz, & Reback, 2017 ; Vocci & Montoya, 2009 ).…”