A Systematic Review of the Efficacy of Contingency Management for Substance Use Disorders in Low and Middle Income Countries

Mariah M Kalmin; Candice Nicolo; Wahbie Long; David Bodden; Lara Van Nunen; Steven Shoptaw; Jonathan Ipser

doi:10.1007/s12529-023-10197-8

A Systematic Review of the Efficacy of Contingency Management for Substance Use Disorders in Low and Middle Income Countries

Int J Behav Med. 2023 Aug 2. doi: 10.1007/s12529-023-10197-8. Online ahead of print.

Authors

Mariah M Kalmin^#¹, Candice Nicolo^#², Wahbie Long², David Bodden³, Lara Van Nunen⁴, Steven Shoptaw⁵, Jonathan Ipser⁶

Affiliations

¹ Department of Family Medicine, University of California, Los Angeles 1800 Wilshire Blvd., Suite 1800, 90024, Los Angeles, CA, US. mkalmin@mednet.ucla.edu.
² Department of Psychology, University of Cape Town, Cape Town, South Africa.
³ Department of Environmental Health, University of North Carolina, Chapel Hill, Chapel Hill, North, CA, US.
⁴ Department of Neuroscience, University of Cape Town, Cape Town, South Africa.
⁵ Department of Family Medicine, University of California, Los Angeles 1800 Wilshire Blvd., Suite 1800, 90024, Los Angeles, CA, US.
⁶ Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.

^# Contributed equally.

PMID: 37532862
DOI: 10.1007/s12529-023-10197-8

Abstract

Background: The impact of illicit substance use is especially devastating in low-resourced countries where factors such as poverty, unemployment, and inadequate services impede successful treatment. Contingency management (CM) is a treatment for substance use disorders that has shown to be effective in eliciting behaviour change. The efficacy of CM interventions in low and middle income countries (LMICs) has been under explored.

Methods: The aim of this systematic review of randomized controlled trials was to assess measures of CM efficacy in addressing substance use disorders, while also considering contextual moderators of CM in LMICs. A search of PubMed, Scopus, and Cochrane library databases yielded 18 studies for inclusion, from which relevant data were extracted using modified versions of the Cochrane Characteristics of Studies tool.

Results: Two studies were located in a low-income country, two in lower-middle income countries, and fourteen in upper middle-income countries. Overall, estimated efficacy estimates were similar to those from higher income countries. However, context-specific challenges that warrant further investigation included limited access to trained staff and structural and financial constraints.

Conclusions: While CM in LMICs is in its early stages of development, efficacy estimates were not substantially different compared to high income countries. Challenges such as costs, willingness to implement, and the stigma associated with addiction sets the stage for further research in these contexts.

Keywords: Contingency management; Low and middle income countries; Substance use disorders; Substance use treatment.

Publication types

Review

Grants and funding

R21DA040492/DA/NIDA NIH HHS/United States