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Meta-Analysis
. 2019 Nov;114(11):1915-1925.
doi: 10.1111/add.14725. Epub 2019 Jul 27.

Mobile telephone-delivered contingency management interventions promoting behaviour change in individuals with substance use disorders: a meta-analysis

Carol-Ann Getty  1   2 , Ana Morande  1   2 , Michael Lynskey  1   2 , Tim Weaver  1   2 , Nicola Metrebian  1   2
Affiliations
Meta-Analysis

Mobile telephone-delivered contingency management interventions promoting behaviour change in individuals with substance use disorders: a meta-analysis

Carol-Ann Getty et al. Addiction. 2019 Nov.

Abstract

Background/aims: Contingency management (CM) interventions have gained considerable interest due to their success in the treatment of addiction. However, their implementation can be resource-intensive for clinical staff. Mobile telephone-based systems might offer a low-cost alternative. This approach could facilitate remote monitoring of behaviour and delivery of the reinforcer and minimize issues of staffing and resources. This systematic review and meta-analysis assessed the evidence for the effectiveness of mobile telephone-delivered CM interventions to promote abstinence (from drugs, alcohol and tobacco), medication adherence and treatment engagement among individuals with substance use disorders.

Design: A systematic search of databases (PsychINFO, CINAHL, MEDLINE PubMed, CENTRAL, Embase) for randomized controlled trials and within-subject design studies (1995-2019). The review was conducted in accordance with the PRISMA statement. The protocol was registered on PROSPERO.

Setting: All included studies originated in the United states.

Participants: Seven studies were found, including 222 participants; two targeted alcohol abstinence among frequent drinkers and four targeted smoking cessation (in homeless veterans and those with post-traumatic stress disorder). One targeted medication adherence.

Measures: The efficacy of CM to increase alcohol and nicotine abstinence was compared with control using several outcomes; percentage of negative samples (PNS), quit rate (QR) and longest duration abstinent (LDA) at the end of the intervention.

Findings: The random-effects meta-analyses produced pooled effect sizes of; PNS [d = 0.94, 95% confidence interval (CI) = 0.63-1.25], LDA (d = 1.08, 95% CI = 0.69-1.46) and QR (d = 0.46, 95% CI = 0.27-0.66), demonstrating better outcomes across the CM conditions. Most of the studies were rated as of moderate quality. 'Fail-safe N' computations for PNS indicated that 50 studies would be needed to produce a non-significant overall effect size. None could be calculated for QR and LDA due to insufficient number of studies.

Conclusion: Mobile telephone-delivered contingency management performs significantly better than control conditions in reducing tobacco and alcohol use among adults not in treatment for substance use disorders.

Keywords: Contingency management; drug use; financial incentives; mobile telephone; remote monitoring; substance use.

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Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flow diagram [Colour figure can be viewed at http://wileyonlinelibrary.com]
Figure 2
Figure 2
Forest plot for percentage negative samples by end of treatment for all substances [Colour figure can be viewed at http://wileyonlinelibrary.com]
Figure 3
Figure 3
Forest plot for quit rate by end of treatment for nicotine [Colour figure can be viewed at http://wileyonlinelibrary.com]
Figure 4
Figure 4
Forest plot for longest duration abstinent for all substances [Colour figure can be viewed at http://wileyonlinelibrary.com]
See this image and copyright information in PMC

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