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Contingency Management for Patients Receiving Medication for Opioid Use DisorderA Systematic Review and Meta-analysis

Educational 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.
1 Credit CME
Key Points

Question  Is contingency management associated with outcomes for treating comorbid substance use and treatment nonadherence among patients receiving medication for opioid use disorder?

Findings  In this systematic review and meta-analysis that included 74 randomized clinical trials and 10 444 adults receiving medication for opioid use disorder, the efficacy of contingency management was associated with abstinence from 4 types of substance use (psychomotor stimulants, polysubstance use, illicit opioids, and cigarettes) and improved treatment attendance and medication adherence.

Meaning  These results provide evidence supporting the use of contingency management for addressing common and serious clinical problems among patients receiving medication for opioid use disorder.


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 Systematic Reviews and Meta-analyses (PRISMA) reporting guideline, 3 independent investigators extracted data from included studies for a random-effects meta-analysis.

Main Outcomes and Measures  Primary 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.

Results  The 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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Article Information

Corresponding Author: Stephen T. Higgins, PhD, Department of Psychiatry, University of Vermont, 1 S Prospect St, UHC, MS482, Burlington, VT 05401 (stephen.higgins@uvm.edu).

Accepted for Publication: May 29, 2021.

Published Online: August 4, 2021. doi:10.1001/jamapsychiatry.2021.1969

Correction: This article was corrected on January 26, 2022, to fix errors in the Figures.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Bolívar HA et al. JAMA Psychiatry.

Author Contributions: Dr Bolívar and Mr DeSarno had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Bolívar, Coleman, Higgins.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Bolívar, Klemperer, Coleman, Higgins.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: DeSarno, Skelly, Higgins.

Obtained funding: Higgins.

Administrative, technical, or material support: Bolívar, Klemperer.

Supervision: Bolívar, Higgins.

Conflict of Interest Disclosures: Drs Coleman, Higgins, and Klemperer have research support from the National Institute of General Medical Sciences and the National Institute on Drug Abuse. No other disclosures were reported.

Funding/Support: This project was supported by a Centers of Biomedical Research Excellence award from the National Institute on General Medical Sciences (P20GM103644) and Institutional Training award from the National Institute on Drug Abuse (T32DA007242).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of General Medical Sciences and the National Institute on Drug Abuse.

Meeting Presentation: Data from this project were presented at the National Institute of Health’s Helping to End Addiction Long-term (HEAL) Meeting—Opioid Use in the Context of Polysubstance Use: Research Opportunities for Prevention, Treatment, and Sustained Recovery meeting; April 14, 2021; virtual and HEAL Principal Investigators Meeting; May 18, 2021; virtual.

Additional Contributions: We extend deep appreciation to Tyler D. Nighbor, PhD, for his help developing and conducting the initial search for relevant literature. Dr Nighbor was not compensated.

Substance Abuse and Mental Health Services Administration. 2019 NSDUH Annual National Report. Published September 11, 2020. Accessed April 6, 2021. https://www.samhsa.gov/data/report/2019-nsduh-annual-national-report
Scholl  L , Seth  P , Kariisa  M , Wilson  N , Baldwin  G .  Drug and opioid-involved overdose deaths: United States, 2013-2017.   MMWR Morb Mortal Wkly Rep. 2018;67(5152):1419-1427. doi:10.15585/mmwr.mm675152e1PubMedGoogle ScholarCrossref
Woolf  SH , Schoomaker  H .  Life expectancy and mortality rates in the United States, 1959-2017.   JAMA. 2019;322(20):1996-2016. doi:10.1001/jama.2019.16932PubMedGoogle ScholarCrossref
Murphy  SM .  The cost of opioid use disorder and the value of aversion.   Drug Alcohol Depend. 2020;217:108382. doi:10.1016/j.drugalcdep.2020.108382PubMedGoogle Scholar
Cicero  TJ , Ellis  MS , Kasper  ZA .  Polysubstance use: a broader understanding of substance use during the opioid crisis.   Am J Public Health. 2020;110(2):244-250. doi:10.2105/AJPH.2019.305412PubMedGoogle ScholarCrossref
Mattick  RP , Breen  C , Kimber  J , Davoli  M .  Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.   Cochrane Database Syst Rev. 2014;(2):CD002207. doi:10.1002/14651858.CD002207.pub4Google Scholar
Paulus  MP , Stewart  JL .  Neurobiology, clinical presentation, and treatment of methamphetamine use disorder: a review.   JAMA Psychiatry. 2020;77(9):959-966. doi:10.1001/jamapsychiatry.2020.0246PubMedGoogle ScholarCrossref
Tsui  JI , Mayfield  J , Speaker  EC ,  et al.  Association between methamphetamine use and retention among patients with opioid use disorders treated with buprenorphine.   J Subst Abuse Treat. 2020;109:80-85. doi:10.1016/j.jsat.2019.10.005PubMedGoogle ScholarCrossref
National Institute on Drug Abuse. Overdose death rates. Published March 20, 2020. Accessed April 22, 2020. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Trivedi  MH , Walker  R , Ling  W ,  et al.  Bupropion and naltrexone in methamphetamine use disorder.   N Engl J Med. 2021;384(2):140-153. doi:10.1056/NEJMoa2020214PubMedGoogle ScholarCrossref
Brandt  L , Chao  T , Comer  SD , Levin  FR .  Pharmacotherapeutic strategies for treating cocaine use disorder: what do we have to offer?   Addiction. 2021;116(4):694-710. doi:10.1111/add.15242PubMedGoogle ScholarCrossref
De Crescenzo  F , Ciabattini  M , D’Alò  GL ,  et al.  Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: a systematic review and network meta-analysis.   PLoS Med. 2018;15(12):e1002715. doi:10.1371/journal.pmed.1002715PubMedGoogle Scholar
Griffith  JD , Rowan-Szal  GA , Roark  RR , Simpson  DD .  Contingency management in outpatient methadone treatment: a meta-analysis.   Drug Alcohol Depend. 2000;58(1-2):55-66. doi:10.1016/S0376-8716(99)00068-XPubMedGoogle ScholarCrossref
Ainscough  TS , McNeill  A , Strang  J , Calder  R , Brose  LS .  Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: a systematic review and meta-analysis.   Drug Alcohol Depend. 2017;178:318-339. doi:10.1016/j.drugalcdep.2017.05.028PubMedGoogle ScholarCrossref
The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One. Released April 1, 2021. Accessed April 6, 2021. https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf?fbclid=IwAR2TBk34U_XRqlqK_pAYnUd_9f7zY3IbCQI9KxI6S5eYeRJdFzl9B09hZ84Published
WebPlotDigitizer. Accessed June 29, 2021. https://automeris.io/WebPlotDigitizer/
Dunn  K , DeFulio  A , Everly  JJ ,  et al.  Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes.   Psychol Addict Behav. 2015;29(2):270-276. doi:10.1037/adb0000010PubMedGoogle ScholarCrossref
DeFulio  A , Silverman  K .  Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post-intervention outcomes.   Addiction. 2011;106(5):960-967. doi:10.1111/j.1360-0443.2011.03364.xPubMedGoogle ScholarCrossref
Kosten  T , Poling  J , Oliveto  A .  Effects of reducing contingency management values on heroin and cocaine use for buprenorphine- and desipramine-treated patients.   Addiction. 2003;98(5):665-671. doi:10.1046/j.1360-0443.2003.00380.xPubMedGoogle ScholarCrossref
Higgins  ST , Heil  SH , Dantona  R , Donham  R , Matthews  M , Badger  GJ .  Effects of varying the monetary value of voucher-based incentives on abstinence achieved during and following treatment among cocaine-dependent outpatients.   Addiction. 2007;102(2):271-281. doi:10.1111/j.1360-0443.2006.01664.xPubMedGoogle ScholarCrossref
Thomas  BH , Ciliska  D , Dobbins  M , Micucci  S .  A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions.   Worldviews Evid Based Nurs. 2004;1(3):176-184. doi:10.1111/j.1524-475X.2004.04006.xPubMedGoogle ScholarCrossref
Cohen  J.,   Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Academic Press; 1988.
Lussier  JP , Heil  SH , Mongeon  JA , Badger  GJ , Higgins  ST .  A meta-analysis of voucher-based reinforcement therapy for substance use disorders.   Addiction. 2006;101(2):192-203. doi:10.1111/j.1360-0443.2006.01311.xPubMedGoogle ScholarCrossref
Umbricht  A , DeFulio  A , Winstanley  EL ,  et al.  Topiramate for cocaine dependence during methadone maintenance treatment: a randomized controlled trial.   Drug Alcohol Depend. 2014;140:92-100. doi:10.1016/j.drugalcdep.2014.03.033PubMedGoogle ScholarCrossref
Preston  KL , Umbricht  A , Wong  CJ , Epstein  DH .  Shaping cocaine abstinence by successive approximation.   J Consult Clin Psychol. 2001;69(4):643-654. doi:10.1037/0022-006X.69.4.643PubMedGoogle ScholarCrossref
Winstanley  EL , Bigelow  GE , Silverman  K , Johnson  RE , Strain  EC .  A randomized controlled trial of fluoxetine in the treatment of cocaine dependence among methadone-maintained patients.   J Subst Abuse Treat. 2011;40(3):255-264. doi:10.1016/j.jsat.2010.11.010PubMedGoogle ScholarCrossref
Petry  NM , Peirce  JM , Stitzer  ML ,  et al.  Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study.   Arch Gen Psychiatry. 2005;62(10):1148-1156. doi:10.1001/archpsyc.62.10.1148PubMedGoogle ScholarCrossref
Blanken  P , Hendriks  VM , Huijsman  IA , van Ree  JM , van den Brink  W .  Efficacy of cocaine contingency management in heroin-assisted treatment: results of a randomized controlled trial.   Drug Alcohol Depend. 2016;164:55-63. doi:10.1016/j.drugalcdep.2016.04.018PubMedGoogle ScholarCrossref
Rawson  RA , Huber  A , McCann  M ,  et al.  A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence.   Arch Gen Psychiatry. 2002;59(9):817-824. doi:10.1001/archpsyc.59.9.817PubMedGoogle ScholarCrossref
Rowan-Szal  GA , Bartholomew  NG , Chatham  LR , Simpson  DD .  A combined cognitive and behavioral intervention for cocaine-using methadone clients.   J Psychoactive Drugs. 2005;37(1):75-84. doi:10.1080/02791072.2005.10399750PubMedGoogle ScholarCrossref
Festinger  DS , Dugosh  KL , Kirby  KC , Seymour  BL .  Contingency management for cocaine treatment: cash vs. vouchers.   J Subst Abuse Treat. 2014;47(2):168-174. doi:10.1016/j.jsat.2014.03.001PubMedGoogle ScholarCrossref
Petry  NM , Alessi  SM , Hanson  T , Sierra  S .  Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients.   J Consult Clin Psychol. 2007;75(6):983-991. doi:10.1037/0022-006X.75.6.983PubMedGoogle ScholarCrossref
Kirby  KC , Carpenedo  CM , Dugosh  KL ,  et al.  Randomized clinical trial examining duration of voucher-based reinforcement therapy for cocaine abstinence.   Drug Alcohol Depend. 2013;132(3):639-645. doi:10.1016/j.drugalcdep.2013.04.015PubMedGoogle ScholarCrossref
Katz  EC , Chutuape  MA , Jones  HE , Stitzer  ML .  Voucher reinforcement for heroin and cocaine abstinence in an outpatient drug-free program.   Exp Clin Psychopharmacol. 2002;10(2):136-143. doi:10.1037/1064-1297.10.2.136PubMedGoogle ScholarCrossref
DeFulio  A , Donlin  WD , Wong  CJ , Silverman  K .  Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: a randomized controlled trial.   Addiction. 2009;104(9):1530-1538. doi:10.1111/j.1360-0443.2009.02657.xPubMedGoogle ScholarCrossref
Epstein  DH , Hawkins  WE , Covi  L , Umbricht  A , Preston  KL .  Cognitive-behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up.   Psychol Addict Behav. 2003;17(1):73-82. doi:10.1037/0893-164X.17.1.73PubMedGoogle ScholarCrossref
Silverman  K , Wong  CJ , Needham  M ,  et al.  A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users.   J Appl Behav Anal. 2007;40(3):387-410. doi:10.1901/jaba.2007.40-387PubMedGoogle ScholarCrossref
Silverman  K , Chutuape  MA , Bigelow  GE , Stitzer  ML .  Voucher-based reinforcement of cocaine abstinence in treatment-resistant methadone patients: effects of reinforcement magnitude.   Psychopharmacology (Berl). 1999;146(2):128-138. doi:10.1007/s002130051098PubMedGoogle ScholarCrossref
Silverman  K , Robles  E , Mudric  T , Bigelow  GE , Stitzer  ML .  A randomized trial of long-term reinforcement of cocaine abstinence in methadone-maintained patients who inject drugs.   J Consult Clin Psychol. 2004;72(5):839-854. doi:10.1037/0022-006X.72.5.839PubMedGoogle ScholarCrossref
Silverman  K , Higgins  ST , Brooner  RK ,  et al.  Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy.   Arch Gen Psychiatry. 1996;53(5):409-415. doi:10.1001/archpsyc.1996.01830050045007PubMedGoogle ScholarCrossref
Silverman  K , Wong  CJ , Umbricht-Schneiter  A , Montoya  ID , Schuster  CR , Preston  KL .  Broad beneficial effects of cocaine abstinence reinforcement among methadone patients.   J Consult Clin Psychol. 1998;66(5):811-824. doi:10.1037/0022-006X.66.5.811PubMedGoogle ScholarCrossref
Gross  A , Marsch  LA , Badger  GJ , Bickel  WK .  A comparison between low-magnitude voucher and buprenorphine medication contingencies in promoting abstinence from opioids and cocaine.   Exp Clin Psychopharmacol. 2006;14(2):148-156. doi:10.1037/1064-1297.14.2.148PubMedGoogle ScholarCrossref
Carroll  KM , Ball  SA , Nich  C ,  et al.  Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence: efficacy of contingency management and significant other involvement.   Arch Gen Psychiatry. 2001;58(8):755-761. doi:10.1001/archpsyc.58.8.755PubMedGoogle ScholarCrossref
Tuten  M , Svikis  DS , Keyser-Marcus  L , O’Grady  KE , Jones  HE .  Lessons learned from a randomized trial of fixed and escalating contingency management schedules in opioid-dependent pregnant women.   Am J Drug Alcohol Abuse. 2012;38(4):286-292. doi:10.3109/00952990.2011.643977PubMedGoogle ScholarCrossref
Kosten  T , Oliveto  A , Feingold  A ,  et al.  Desipramine and contingency management for cocaine and opiate dependence in buprenorphine maintained patients.   Drug Alcohol Depend. 2003;70(3):315-325. doi:10.1016/S0376-8716(03)00032-2PubMedGoogle ScholarCrossref
Downey  KK , Helmus  TC , Schuster  CR .  Treatment of heroin-dependent poly-drug abusers with contingency management and buprenorphine maintenance.   Exp Clin Psychopharmacol. 2000;8(2):176-184. doi:10.1037/1064-1297.8.2.176PubMedGoogle ScholarCrossref
Schottenfeld  RS , Chawarski  MC , Pakes  JR , Pantalon  MV , Carroll  KM , Kosten  TR .  Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence.   Am J Psychiatry. 2005;162(2):340-349. doi:10.1176/appi.ajp.162.2.340PubMedGoogle ScholarCrossref
Iguchi  MY , Belding  MA , Morral  AR , Lamb  RJ , Husband  SD .  Reinforcing operants other than abstinence in drug abuse treatment: an effective alternative for reducing drug use.   J Consult Clin Psychol. 1997;65(3):421-428. doi:10.1037/0022-006X.65.3.421PubMedGoogle ScholarCrossref
Bickel  WK , Marsch  LA , Buchhalter  AR , Badger  GJ .  Computerized behavior therapy for opioid-dependent outpatients: a randomized controlled trial.   Exp Clin Psychopharmacol. 2008;16(2):132-143. doi:10.1037/1064-1297.16.2.132PubMedGoogle ScholarCrossref
Katz  EC , Chutuape  MA , Jones  H , Jasinski  D , Fingerhood  M , Stitzer  M .  Abstinence incentive effects in a short-term outpatient detoxification program.   Exp Clin Psychopharmacol. 2004;12(4):262-268. doi:10.1037/1064-1297.12.4.262PubMedGoogle ScholarCrossref
Brooner  RK , Kidorf  MS , King  VL , Stoller  KB , Neufeld  KJ , Kolodner  K .  Comparing adaptive stepped care and monetary-based voucher interventions for opioid dependence.   Drug Alcohol Depend. 2007;88(suppl 2):S14-S23. doi:10.1016/j.drugalcdep.2006.12.006Google Scholar
Petry  NM , Alessi  SM , Barry  D , Carroll  KM .  Standard magnitude prize reinforcers can be as efficacious as larger magnitude reinforcers in cocaine-dependent methadone patients.   J Consult Clin Psychol. 2015;83(3):464-472. doi:10.1037/a0037888PubMedGoogle ScholarCrossref
Epstein  DH , Schmittner  J , Umbricht  A , Schroeder  JR , Moolchan  ET , Preston  KL .  Promoting abstinence from cocaine and heroin with a methadone dose increase and a novel contingency.   Drug Alcohol Depend. 2009;101(1-2):92-100. doi:10.1016/j.drugalcdep.2008.11.006PubMedGoogle ScholarCrossref
Peirce  JM , Petry  NM , Stitzer  ML ,  et al.  Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study.   Arch Gen Psychiatry. 2006;63(2):201-208. doi:10.1001/archpsyc.63.2.201PubMedGoogle ScholarCrossref
Carroll  KM , Sinha  R , Nich  C , Babuscio  T , Rounsaville  BJ .  Contingency management to enhance naltrexone treatment of opioid dependence: a randomized clinical trial of reinforcement magnitude.   Exp Clin Psychopharmacol. 2002;10(1):54-63. doi:10.1037/1064-1297.10.1.54PubMedGoogle ScholarCrossref
Piotrowski  NA , Tusel  DJ , Sees  KL ,  et al.  Contingency contracting with monetary reinforcers for abstinence from multiple drugs in a methadone program.   Exp Clin Psychopharmacol. 1999;7(4):399-411. doi:10.1037/1064-1297.7.4.399PubMedGoogle ScholarCrossref
Petry  NM , Martin  B .  Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients.   J Consult Clin Psychol. 2002;70(2):398-405. doi:10.1037/0022-006X.70.2.398PubMedGoogle ScholarCrossref
Petry  NM , Alessi  SM , Ledgerwood  DM .  A randomized trial of contingency management delivered by community therapists.   J Consult Clin Psychol. 2012;80(2):286-298. doi:10.1037/a0026826PubMedGoogle ScholarCrossref
Oliveto  A , Poling  J , Sevarino  KA ,  et al.  Efficacy of dose and contingency management procedures in LAAM-maintained cocaine-dependent patients.   Drug Alcohol Depend. 2005;79(2):157-165. doi:10.1016/j.drugalcdep.2005.01.007PubMedGoogle ScholarCrossref
Hser  YI , Li  J , Jiang  H ,  et al.  Effects of a randomized contingency management intervention on opiate abstinence and retention in methadone maintenance treatment in China.   Addiction. 2011;106(10):1801-1809. doi:10.1111/j.1360-0443.2011.03490.xPubMedGoogle ScholarCrossref
Jiang  H , Du  J , Wu  F ,  et al.  Efficacy of contingency management in improving retention and compliance to methadone maintenance treatment: a random controlled study.   Shanghai Arch Psychiatry. 2012;24(1):11-19. doi:10.3969/j.issn.1002-0829.2012.01.002PubMedGoogle Scholar
Ling  W , Hillhouse  M , Ang  A , Jenkins  J , Fahey  J .  Comparison of behavioral treatment conditions in buprenorphine maintenance.   Addiction. 2013;108(10):1788-1798. doi:10.1111/add.12266PubMedGoogle ScholarCrossref
Jarvis  BP , Holtyn  AF , DeFulio  A ,  et al.  The effects of extended-release injectable naltrexone and incentives for opiate abstinence in heroin-dependent adults in a model therapeutic workplace: a randomized trial.   Drug Alcohol Depend. 2019;197:220-227. doi:10.1016/j.drugalcdep.2018.12.026PubMedGoogle ScholarCrossref
Robles  E , Stitzer  ML , Strain  EC , Bigelow  GE , Silverman  K .  Voucher-based reinforcement of opiate abstinence during methadone detoxification.   Drug Alcohol Depend. 2002;65(2):179-189. doi:10.1016/S0376-8716(01)00160-0PubMedGoogle ScholarCrossref
Chen  W , Hong  Y , Zou  X , McLaughlin  MM , Xia  Y , Ling  L .  Effectiveness of prize-based contingency management in a methadone maintenance program in China.   Drug Alcohol Depend. 2013;133(1):270-274. doi:10.1016/j.drugalcdep.2013.05.028PubMedGoogle ScholarCrossref
Correia  CJ , Dallery  J , Katz  EC , Silverman  K , Bigelow  G , Stitzer  ML .  Single- versus dual-drug target: effects in a brief abstinence incentive procedure.   Exp Clin Psychopharmacol. 2003;11(4):302-308. doi:10.1037/1064-1297.11.4.302PubMedGoogle ScholarCrossref
McCaul  ME , Stitzer  ML , Bigelow  GE , Liebson  IA .  Contingency management interventions: effects on treatment outcome during methadone detoxification.   J Appl Behav Anal. 1984;17(1):35-43. doi:10.1901/jaba.1984.17-35PubMedGoogle ScholarCrossref
Preston  KL , Umbricht  A , Epstein  DH .  Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance.   Arch Gen Psychiatry. 2000;57(4):395-404. doi:10.1001/archpsyc.57.4.395PubMedGoogle ScholarCrossref
Sigmon  SC , Miller  ME , Meyer  AC ,  et al.  Financial incentives to promote extended smoking abstinence in opioid-maintained patients: a randomized trial.   Addiction. 2016;111(5):903-912. doi:10.1111/add.13264PubMedGoogle ScholarCrossref
Tuten  M , Fitzsimons  H , Chisolm  MS , Nuzzo  PA , Jones  HE .  Contingent incentives reduce cigarette smoking among pregnant, methadone-maintained women: results of an initial feasibility and efficacy randomized clinical trial.   Addiction. 2012;107(10):1868-1877. doi:10.1111/j.1360-0443.2012.03923.xPubMedGoogle ScholarCrossref
Dunn  KE , Sigmon  SC , Reimann  EF , Badger  GJ , Heil  SH , Higgins  ST .  A contingency-management intervention to promote initial smoking cessation among opioid-maintained patients.   Exp Clin Psychopharmacol. 2010;18(1):37-50. doi:10.1037/a0018649PubMedGoogle ScholarCrossref
Kidorf  M , Brooner  RK , Leoutsakos  JM , Peirce  J .  Treatment initiation strategies for syringe exchange referrals to methadone maintenance: a randomized clinical trial.   Drug Alcohol Depend. 2018;187:343-350. doi:10.1016/j.drugalcdep.2018.03.009PubMedGoogle ScholarCrossref
Rhodes  GL , Saules  KK , Helmus  TC ,  et al.  Improving on-time counseling attendance in a methadone treatment program: a contingency management approach.   Am J Drug Alcohol Abuse. 2003;29(4):759-773. doi:10.1081/ADA-120026259PubMedGoogle ScholarCrossref
Jones  HE , Haug  NA , Stitzer  ML , Svikis  DS .  Improving treatment outcomes for pregnant drug-dependent women using low-magnitude voucher incentives.   Addict Behav. 2000;25(2):263-267. doi:10.1016/S0306-4603(98)00119-1PubMedGoogle ScholarCrossref
Kidorf  M , Brooner  RK , Gandotra  N ,  et al.  Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial.   Drug Alcohol Depend. 2013;133(1):30-36. doi:10.1016/j.drugalcdep.2013.06.005PubMedGoogle ScholarCrossref
Preston  KL , Silverman  K , Umbricht  A , DeJesus  A , Montoya  ID , Schuster  CR .  Improvement in naltrexone treatment compliance with contingency management.   Drug Alcohol Depend. 1999;54(2):127-135. doi:10.1016/S0376-8716(98)00152-5PubMedGoogle ScholarCrossref
Everly  JJ , DeFulio  A , Koffarnus  MN ,  et al.  Employment-based reinforcement of adherence to depot naltrexone in unemployed opioid-dependent adults: a randomized controlled trial.   Addiction. 2011;106(7):1309-1318. doi:10.1111/j.1360-0443.2011.03400.xPubMedGoogle ScholarCrossref
DeFulio  A , Everly  JJ , Leoutsakos  JM ,  et al.  Employment-based reinforcement of adherence to an FDA approved extended release formulation of naltrexone in opioid-dependent adults: a randomized controlled trial.   Drug Alcohol Depend. 2012;120(1-3):48-54. doi:10.1016/j.drugalcdep.2011.06.023PubMedGoogle ScholarCrossref
Sorensen  JL , Haug  NA , Delucchi  KL ,  et al.  Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial.   Drug Alcohol Depend. 2007;88(1):54-63. doi:10.1016/j.drugalcdep.2006.09.019PubMedGoogle ScholarCrossref
Dunn  KE , Defulio  A , Everly  JJ ,  et al.  Employment-based reinforcement of adherence to oral naltrexone treatment in unemployed injection drug users.   Exp Clin Psychopharmacol. 2013;21(1):74-83. doi:10.1037/a0030743PubMedGoogle ScholarCrossref
Weaver  T , Metrebian  N , Hellier  J ,  et al.  Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial.   Lancet. 2014;384(9938):153-163. doi:10.1016/S0140-6736(14)60196-3PubMedGoogle ScholarCrossref
Magnusson  K. Interpreting Cohen’s d effect size: an interactive visualization. R Psychologist. Accessed May 21, 2021. https://rpsychologist.com/cohend/
McLellan  AT , Lewis  DC , O’Brien  CP , Kleber  HD .  Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation.   JAMA. 2000;284(13):1689-1695. doi:10.1001/jama.284.13.1689PubMedGoogle ScholarCrossref
Higgins  ST , Wong  CJ , Badger  GJ , Ogden  DE , Dantona  RL .  Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up.   J Consult Clin Psychol. 2000;68(1):64-72. doi:10.1037/0022-006X.68.1.64PubMedGoogle ScholarCrossref
Silverman  K , DeFulio  A , Sigurdsson  SO .  Maintenance of reinforcement to address the chronic nature of drug addiction.   Prev Med. 2012;55(suppl):S46-S53. doi:10.1016/j.ypmed.2012.03.013PubMedGoogle ScholarCrossref
Office of Inspector General (OIG), HHS.  Medicare and state health care programs: fraud and abuse; revisions to the safe harbors under the anti-kickback statute and civil monetary penalty rules regarding beneficiary inducements: final rule.   Fed Regist. 2016;81(235):88368-88409.Google Scholar
US Department of Health & Human Services. About the Affordable Care Act. Last updated March 23, 2021. Accessed January 15, 2021. https://www.hhs.gov/healthcare/about-the-aca/index.html
Baker  TB , Fraser  DL , Kobinsky  K ,  et al.  A randomized controlled trial of financial incentives to low income pregnant women to engage in smoking cessation treatment: effects on post-birth abstinence.   J Consult Clin Psychol. 2018;86(5):464-473. doi:10.1037/ccp0000278PubMedGoogle ScholarCrossref
Centers for Medicare & Medicaid Services. About the partnership. Updated April 5, 2021. Accessed April 1, 2021. https://www.cms.gov/hfpp/about
Oluwoye  O , Kriegel  L , Alcover  KC , McPherson  S , McDonell  MG , Roll  JM .  The dissemination and implementation of contingency management for substance use disorders: a systematic review.   Psychol Addict Behav. 2020;34(1):99-110. doi:10.1037/adb0000487PubMedGoogle ScholarCrossref
Budney  AJ , Higgins  ST, .  A Community Reinforcement Plus Vouchers Approach: Treating Cocaine Addiction. National Institute on Drug Abuse; 1998.
Petry  NM .  Contingency Management for Substance Abuse Treatment: a Guide to Implementing This Evidence-Based Practice. Routledge; 2011.
Ranganathan  M , Lagarde  M .  Promoting healthy behaviours and improving health outcomes in low and middle income countries: a review of the impact of conditional cash transfer programmes.   Prev Med. 2012;55(suppl):S95-S105. doi:10.1016/j.ypmed.2011.11.015PubMedGoogle ScholarCrossref
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication-Assisted Treatment for Opioid Use Disorder. Leshner AI, Mancher M, Eds.  Medications for Opioid Use Disorder Save Lives. National Academies Press; 2019. doi:10.17226/25310
Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health. Accessed June 28, 2021. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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