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

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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.

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Acknowledgements

This research was supported by the National Institute of Drug Abuse (R21DA040492).

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Author notes

  1. Denotes co-first authors, Kalmin and Nicolo contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Family Medicine, University of California, Los Angeles 1800 Wilshire Blvd., Suite 1800, 90024, Los Angeles, CA, US

    Mariah M. Kalmin & Steven Shoptaw

  2. Department of Psychology, University of Cape Town, Cape Town, South Africa

    Candice Nicolo & Wahbie Long

  3. Department of Environmental Health, University of North Carolina, Chapel Hill, Chapel Hill, North, CA, US

    David Bodden

  4. Department of Neuroscience, University of Cape Town, Cape Town, South Africa

    Lara Van Nunen

  5. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Jonathan Ipser

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Correspondence to Mariah M. Kalmin.

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Kalmin, M.M., Nicolo, C., Long, W. et al. A Systematic Review of the Efficacy of Contingency Management for Substance Use Disorders in Low and Middle Income Countries. Int.J. Behav. Med. (2023). https://doi.org/10.1007/s12529-023-10197-8

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