Abstract
Background: Substance use disorders (SUD) are highly prevalent among psychotic patients and are associated with poorer clinical and functional outcomes. Effective interventions for this clinical population are scarce and challenging. Contingency management (CM) is one of the most evidence-based treatments for SUD’s, however, a meta-analysis of the effect of CM in patients with a dual diagnosis of psychotic disorder and SUD has not been performed. Methods: We searched PubMed and PsycINFO databases up to December 2020. Results: Five controlled trials involving 892 patients were included. CM is effective on abstinence rates, measured by the number of self-reported days of using after intervention (95% CI −0.98 to −0.06) and by the number of negative breath or urine samples after intervention (OR 2.13; 95% CI 0.97 to 4.69) and follow-up (OR 1.47; 95% CI 1.04 to 2.08). Conclusions: Our meta-analysis shows a potential effect of CM on abstinence for patients with SUD and (severe) psychotic disorders, although the number of studies is limited. Additional longitudinal studies are needed to confirm the sustained effectivity of CM and give support for a larger clinical implementation of CM within services targeting these vulnerable co-morbid patients.
Highlights
Patients with a psychotic disorder and co-morbid substance use disorder (SUD) are an especially vulnerable group of psychiatric patients
Our meta-analysis shows a potential effect of Contingency management (CM) on abstinence for patients with Substance use disorders (SUD) and psychotic disorders, the number of studies is limited
Eligible papers were extracted from PubMed, PsycINFO, Scopus and Web of Science databases using the following inclusion criteria: (1) English language articles published in peer-reviewed journals, (2) Tested one or more CM intervention(s) in a controlled trial aimed at substance use reduction or abstinence (3) Included patients with psychotic disorders
Summary
Patients with a psychotic disorder and co-morbid substance use disorder (SUD) are an especially vulnerable group of psychiatric patients Research shows that these patients have more symptoms of psychosis and depressive symptoms [1,2], higher relapse and (re)hospitalization rates [3,4], are more likely to have legal and aggression problems [4,5,6], and have higher suicide rates, as well as a lower average age at death [4,7] than psychotic patients without SUD. Additional longitudinal studies are needed to confirm the sustained effectivity of CM and give support for a larger clinical implementation of CM within services targeting these vulnerable co-morbid patients
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