A Scoping Review of Cultural Variables in Contingency Management for Substance Use Disorder
Contingency management works across cultures, but we rarely shape it to fit.
01Research in Context
What this study did
Donohue et al. (2025) searched every CM-for-addiction paper they could find. They asked: Do we check if the program fits the client’s culture?
They looked for mentions of race, language, religion, or other cultural details. They also hunted for studies that tweaked CM to match a group’s values.
What they found
The good news: CM still works across Black, White, Latino, and other groups. The gap: Almost no trial tests if a culturally tuned version works better.
Studies rarely track if clients like the plan or stay longer because it feels respectful. We are flying blind on acceptability.
How this fits with other research
Davidson et al. (2025) show CM beats the math—people quit cocaine even when the prize money looks too small. Donohue adds culture as a missing variable that could make the math even better.
Goodwin et al. (2025) argue today’s stronger drugs need faster, smaller prizes. Donohue agrees and says we must also ask, “Does the prize make sense in this client’s world?”
Jimenez-Gomez et al. (2022) give us the first ABA multicultural toolkit. Donohue’s map shows CM papers rarely open that toolbox.
Why it matters
You already run CM or refer clients to it. This review tells you to add two quick boxes to your intake: “Cultural preference?” and “Would a different reward feel more respectful?” You can test it in one case and see if attendance or urine screens improve. No grant money needed—just ask, adjust, and track.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add a five-question cultural preference survey before the first CM session.
02At a glance
03Original abstract
Researchers and practitioners have been urged to embrace cultural responsiveness to better design, implement, and evaluate treatment. We conducted a scoping review of the inclusion of cultural variables in the context of contingency management (CM) for the treatment of substance use disorder (SUD). We included articles that contained a discussion of at least one cultural variable in the context of CM related to SUD (e.g., race, ethnicity, age, generation, education, socioeconomic status, religion or spiritual beliefs, language, nationality, geographic location, disability, gender identity, sexual orientation). Results suggest that CM may be equally efficacious across sociodemographic categories, and racial, ethnic, and sexual minorities. However, few studies have examined other outcomes as a function of cultural variables, such as uptake, acceptability, adherence, and retention. Few studies have explicitly tailored CM based on cultural variables or compared tailored and nontailored versions of CM. Thus, more work is needed to understand whether and how cultural variables should be considered in contingency management for substance use disorder.
Perspectives on Behavior Science, 2025 · doi:10.1007/s40614-025-00480-2