Contingency Management Rates Best in Comparison of Treatments for Cocaine Use Disorder

In a meta-analysis of 157 clinical trials, contingency management programs were found to be the most beneficial treatment modality for cocaine use disorder among adults.

Findings, compiled by researchers from Stanford University, Veterans Affairs Palo Health Care System and the University of Pennsylvania, were published on JAMA Network Open.

The review looked at clinical trials with “cocaine” in the title that were published between Dec. 31, 1995, and Dec. 31, 2017, included patients at least 18 years of age with active cocaine use at baseline and met several other criteria. An initial pool of 831 records was pared down to 157 studies that met all of the parameters to be included in the analysis. The included 157 studies were comprised of 402 treatment groups and 15,842 participants.

Psychotherapy represented the largest treatment group among the trials reviewed. Only contingency management, however, was significantly associated with an increased likelihood of having a negative test result for cocaine.

“Moreover, large-scale implementation of contingency management programs for the treatment of substance use disorders by the U.S. Department of Veterans Affairs has indicated both clinical benefits similar to those reported in clinical trials and low costs,” the researchers wrote. “Given the results of our study and the fact that the Department of Veterans Affairs is the largest integrated provider of addiction services in the U.S., consideration of the implementation of contingency management programs on a national level or within other major healthcare systems in the U.S. is warranted.”