Contingency Management for Patients Receiving Medication for Opioid Use Disorder: A Systematic Review and Meta-Analysis

Hypatia A. Bolívar
Elias M. Klemperer
Sulamunn R. M. Coleman
Michael DeSarno
Joan M. Skelly
Stephen T. Higgins
Peer-Reviewed Article
August 2021


Evidence-based behavioral intervention in which positive behaviors are reinforced with material incentives may address clinical problems among people receiving medications for opioid use disorder (MOUD).


Although MOUD have demonstrated to be highly effective for people with OUD, the rise of stimulant misuse, such as methamphetamines, can undermine MOUD efficacy, including contributing to disengagement from treatment and a return to illicit opioid use. This systemic review and meta-analysis explores if contingency management is effective for comorbid substance use and treatment nonadherence among patients receiving MOUD. Contingency management is an evidence-based behavioral intervention in which positive behaviors (such as treatment adherence) are reinforced with material incentives (such as cash) that has shown good outcomes for people with stimulant disorders, a disorder that so far lacks evidence-based medication.


The findings support the efficacy of contingency management for addressing at least six serious clinical problems that are common among people receiving MOUD: psychomotor stimulant use, polysubstance use, illicit opioids, cigarette smoking, therapy attendance, and medication adherence. Contingency management was associated with significant increased abstinence, as well as increased treatment adherence (both therapy attendance and medication adherence), compared with controls. The review demonstrated very statistically significant effects of contingency management on abstinence from psychomotor stimulant use.


Contingency management may be an effective approach for public health officials and clinicians to take when treating clinical problems among people receiving MOUD. Policymakers can use this evidence to evaluate coverage of contingency management, particularly given the opioid epidemic and comorbid stimulant use among patients taking MOUD.

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