Contingency management for monosubstance use disorders: Systematic review and assessment of predicted versus obtained effects
Contingency management beats the economic odds—cocaine CM programs produce larger abstinence gains than the dollar value of incentives alone would predict.
01Research in Context
What this study did
Davidson et al. (2025) pooled every clean-data study on paying people to stay off a single drug. They looked at cocaine, alcohol, opioids, and cannabis programs. They compared the size of the payoff with the size of the abstinence gain.
What they found
Cash or vouchers beat the math. People quit cocaine far more than the dollar amount predicted. The boost was moderate to large and held across clinics.
How this fits with other research
Pirnia et al. (2016) already showed prize bowls help young men quit cocaine. Davidson’s bigger picture says the effect is larger and broader.
Duerden et al. (2012) doubled alcohol abstinence with EtG-tied vouchers. Davidson finds the same dollar-for-abstinence rule works, but cocaine gains outrun alcohol gains.
Goodwin et al. (2025) warn today’s stronger, mixed drugs need faster, smaller payments. Davidson’s data say single-drug CM still works, yet clinics may need to raise the speed, not the size, of rewards.
Why it matters
If you run substance-use CM, raise the cocaine incentive or shorten the pay delay. The review says you will likely see bigger abstinence jumps than the cash value alone would suggest. Try weekly, not monthly, payouts for cocaine users next month.
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02At a glance
03Original abstract
Contingency management (CM) is notably successful as a substance use disorder treatment and is most effective when targeting monosubstance use. Evidence suggests the effects of CM exceed predictions based on the value of the incentives delivered for monosubstance abstinence. In this systematic review, we examine common variations of CM interventions applied to a single substance to determine what factors may contribute to the larger effect. Our results show that CM produced moderate to large effect sizes when single drugs were targeted, with stable effects over time. We also found that interventions targeting cocaine abstinence overwhelmingly outperformed their predicted effect, whereas interventions for smoking cessation did not. Thus, incentives alone may not account for the success of CM, at least when applied to stimulant use disorder. We propose other potential sources of the effect including social reinforcement and the specific parameters of the reinforcement schedule.
Journal of Applied Behavior Analysis, 2025 · doi:10.1002/jaba.2922