Systematically giving substance use patients a chance to win valuable prizes if they test abstinent offers a lower-cost alternative to ‘contingency management’ systems which provide rewards each time, but does it work? Across 18 studies the answer was ‘Yes,’ though effects soon faded.

Key points from summary and commentary
• Systematically giving substance use patients the chance to win prizes if they test abstinent offers a lower-cost alternative to other ‘contingency management’ systems which reward every eligible negative test.
• The featured analysis amalgamated findings on these prize-based systems and found a substantial overall effect during the incentives period which had faded to around zero six months after incentives ended.
• More sustained benefits have been found by integrating contingency management with ‘talking’ therapies, and larger effects have been found with higher value rewards