By Substance
Stimulants
(cocaine, methamphetamine)
Over 100 randomized controlled trials support the effectiveness of CM for stimulant use disorder. As a result, the American Society of Addiction Medicine Clinical Practice Guideline on the Management of Stimulant Use Disorder states that CM should be a first-line treatment for cocaine and methamphetamine use. Meta-analyses (studies of studies) found that CM is associated with medium to large reduction in stimulant use and that these reductions are superior to cognitive behavioral therapy.
Bentzley, B. S., Han, S. S., Neuner, S., Humphreys, K., Kampman, K. M., & Halpern, C. H. (2021). Comparison of treatments for cocaine use disorder among adults: A systematic review and meta-analysis. JAMA Network Open, 4(5), e218049.
AshaRani, P. V., Hombali, A., Seow, E., Ong, W. J., Tan, J. H., & Subramaniam, M. (2020). Non-pharmacological interventions for methamphetamine use disorder: A systematic review. Drug and Alcohol Dependence, 212, 108060.
Petry, N. M., Peirce, J. M., Stitzer, M. L., Blaine, J., Roll, J. M., Cohen, A., Obert, J., Killeen, T., Saladin, M. E., Cowell, M., Kirby, K. C., Sterling, R., Royer-Malvestuto, C., Hamilton, J., Booth, R. E., Macdonald, M., Liebert, M., Rader, L., Burns, R., … Li, R. (2005). Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry, 62(10), 1148–1156. https://doi.org/10.1001/archpsyc.62.10.1148
Higgins, S. T., Delaney, D. D., Budney, A. J., Bickel, W. K., Hughes, J. R., Foerg, F., & Fenwick, J. W. (1991). A behavioral approach to achieving initial cocaine abstinence. American Journal of Psychiatry, 148(9), 1218–1224.
Opioids
While CM is an effective treatment for opioid use disorder (OUD), medications like buprenorphine and methadone are highly effective and should be offered to all patients with OUD. Research supports that CM is effective at treating the co-use of stimulant drugs for people are using opioid or receiving medications to treat their opioid use disorder. CM is also an effective way to increase medication compliance for those who have difficulty adhering to their medications for opioid use disorder.
Bolívar, H. A., Klemperer, E. M., Coleman, S. R. M., DeSarno, M., Skelly, J. M., & Higgins, S. T. (2021). Contingency management for patients receiving medication for opioid use disorder: A systematic review and meta-analysis. JAMA Psychiatry, 78(10), 1092–1102. https://doi.org/10.1001/jamapsychiatry.2021.1969
Holtyn, A. F., Koffarnus, M. N., DeFulio, A., Sigurdsson, S. O., Strain, E. C., Schwartz, R. P., Leoutsakos, J.-M. S., & Silverman, K. (2014). The therapeutic workplace to promote treatment engagement and drug abstinence in out-of-treatment injection drug users: A randomized controlled trial. Preventive Medicine, 68, 62–70.
Peirce, J. M., Petry, N. M., Stitzer, M. L., Blaine, J., Kellogg, S., Satterfield, F., Schwartz, M., Krasnansky, J., Pencer, E., Silva-Vazquez, L., Kirby, K. C., Royer-Malvestuto, C., Roll, J. M., Cohen, A., Copersino, M. L., Kolodner, K., & Li, R. (2006). Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry, 63(2), 201–208. https://doi.org/10.1001/archpsyc.63.2.201
Alcohol
CM is associated with medium to large reductions in alcohol use. Urine ethyl glucuronide (uEtG) tests can be used to implement an outpatient CM intervention for alcohol use disorders. Other alcohol tests can be used to implement CM, such as alcohol breath tests (assessed by smartphone synced breathalyzers), phosphatidylethanol (PEth), and transdermal alcohol monitors, though there is less evidence for these approaches.
McDonell, M. G., Hirchak, K. A., Herron, J., Lyons, A. J., Alcover, K. C., Shaw, J., Kordas, G., Dirks, L. G., Jansen, K., Avey, J., Lillie, K., Donovan, D., McPherson, S. M., Dillard, D., Ries, R., Roll, J., Buchwald, D., Lengele, B., Echo-Hawk, A., … Skalisky, J. (2021). Effect of incentives for alcohol abstinence in partnership with 3 American Indian and Alaska Native communities: A randomized clinical trial. JAMA Psychiatry, 78(6), 599–606. https://doi.org/10.1001/jamapsychiatry.2020.4768
McDonell, M. G., Skalisky, J., Burduli, E., Foote, A., Granbois, A., Smoker, K., Hirchak, K., Herron, J., Ries, R. K., Echo-Hawk, A., Barbosa-Leiker, C., Buchwald, D., Roll, J., & McPherson, S. M. (2021). The rewarding recovery study: A randomized controlled trial of incentives for alcohol and drug abstinence with a rural American Indian community. Addiction, 116(6), 1569–1579. https://doi.org/10.1111/add.15349
McDonell, M. G., Leickly, E., McPherson, S., Skalisky, J., Srebnik, D., Angelo, F., Vilardaga, R., Nepom, J. R., Roll, J. M., & Ries, R. K. (2017). A randomized controlled trial of ethyl glucuronide-based contingency management for outpatients with co-occurring alcohol use disorders and serious mental illness. American Journal of Psychiatry, 174(4), 370–377. https://doi.org/10.1176/appi.ajp.2016.16050627
Petry, N. M., Martin, B., Cooney, J. L., & Kranzler, H. R. (2000). Give them prizes, and they will come: Contingency management for treatment of alcohol dependence. Journal of Consulting and Clinical Psychology, 68(2), 250–257.
Tobacco
CM for nicotine use disorder is associated with quit rates that are superior to other approaches like nicotine replacement treatment. Carbon monoxide monitors and urine cotinine tests can be used to implement CM for cigarette smoking. They can be used in combination with other pharmacological treatments, such as nicotine replacement treatment or varenicline.
Notley, C., Gentry, S., Livingstone-Banks, J., Bauld, L., Perera, R., Conde, M., & Hartmann-Boyce, J. (2025). Incentives for smoking cessation. The Cochrane Database of Systematic Reviews, 1(1), CD004307.
https://doi.org/10.1002/14651858.CD004307.pub7
Secades-Villa, R., Aonso-Diego, G., García-Pérez, Á., & González-Roz, A. (2020). Effectiveness of contingency management for smoking cessation in substance users: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 88(10), 951–964. https://doi.org/10.1037/ccp0000611
Cooney, J. L., Cooper, S., Grant, C., Sevarino, K., Krishnan-Sarin, S., Gutierrez, I. A., & Cooney, N. L. (2017). A Randomized Trial of Contingency Management for Smoking Cessation During Intensive Outpatient Alcohol Treatment. Journal of Substance Abuse Treatment, 72, 89–96. https://doi.org/10.1016/j.jsat.2016.07.002
Cannabis
CM is also an effective intervention for cannabis use disorders and is effective as a treatment for adults and youth. CM for cannabis use disorder can be complicated due to the long detection window of cannabis metabolites in urine.
Budney, A. J., Stanger, C., Tilford, J. M., Scherer, E. B., Brown, P. C., Li, Z., Li, Z., & Walker, D. D. (2015). Computer-assisted behavioral therapy and contingency management for cannabis use disorder. Psychology of Addictive Behaviors, 29(3), 501–511.
Stanger, C., Ryan, S. R., Scherer, E. A., Norton, G. E., & Budney, A. J. (2015). Clinic- and home-based contingency management plus parent training for adolescent cannabis use disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 54(6), 445–453.e2. https://doi.org/10.1016/j.jaac.2015.02.009
Litt, M. D., Kadden, R. M., & Petry, N. M. (2013). Behavioral treatment for marijuana dependence: Randomized trial of contingency management and self-efficacy enhancement. Addictive Behaviors, 38(3), 1764–1775.