Contingency management programs linked to decreased cocaine use among adults

1. Contingency management programs were strongly associated with a decreased likelihood of a positive test for the presence of cocaine in active users.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Each day, more than 170 people die from drug overdoses in the United States, while the epidemic of substance use disorders and drug overdose deaths remains a public health crisis. Cocaine overdose is the second leading cause of drug overdose deaths; however, no definitive treatments exist to effectively decrease cocaine use. In this meta-analysis of 157 clinical trials in the UK and US, over 400 treatment groups and more than fifteen thousand participants were included to investigate the association between cocaine use disorder treatments and objective reductions in cocaine use in adults. Amongst the 11 treatments studied, including psychotherapy, placebo, opioids, antidepressants and antipsychotics, only contingency management programs, a type of behavioral therapy with reinforcement of positive behaviors, were significantly associated with a reduction of cocaine use among adults. One strength of this meta-analysis is the broad inclusivity with more than 400 treatment groups and over fifteen thousand participants, done in a methodologically rigorous manner. This increases the likelihood of finding a significant association between treatments and cocaine use reduction, increasing the sensitivity of detecting an effective treatment. However, the broad inclusion criteria also make it difficult to detect the specific potential benefits of individual treatment within a given treatment category, paving the way for further studies examining contingency management in more detail.

Click to read the study in JAMA Network Open

Relevant Reading: Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016

In-Depth [meta-analysis]: In this meta-analysis of 15 842 participants, 157 clinical trials with 402 treatment groups, only contingency management programs were significantly associated with an increase in the likelihood of having a negative urinalysis result for the presence of cocaine for both imputed (OR, 2.13) and nonimputed (OR, 2.09) data sets. Primary and sensitivity analysis did not reveal a significant association between psychotherapy or other treatment plans and an increase in the likelihood of having a negative urinalysis result for the presence of cocaine among adults.

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