Efficacy and Tolerability of Contingency Management and Cognitive-Behavioral Therapy With Pharmacotherapy or Placebo in Managing Stimulant Use Disorder: A Systematic Review and Meta-Analysis

Speaker(s)

Eze U1, Ologunowa A2, Ozota O1, Ufuah U3, Oguguo V4, Onyia I1, Sabastine R1, Ifeanyi R1, Salim J3, Obi O1, Asogwa C5, Ononuju U1, Ben-Umeh K6, Amorha K7
1Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, EN, Nigeria, 2University of Rhode Island, Kingston, RI, USA, 3University of Ibadan, Ibadan, Oyo, Nigeria, 4College of Biomedical Sciences, University of East London, London, UK, 5Maun Hospital, Gaborone, Gaborone, Botswana, 6College of Pharmacy, University of Utah, Salt Lake City, UT, USA, 7University of Nigeria Nsukka, Nsukka, EN, Nigeria

Presentation Documents

OBJECTIVES: This study aimed to evaluate the efficacy and tolerability of psychotherapy (cognitive-behavioral therapy (CBT) and contingency management (CM)) augmented with pharmacotherapy, compared to psychotherapy in addition to a placebo, in the management of stimulant use disorders, through a systematic review and meta-analysis approach.

METHODS: Electronic databases were searched from inception through November 2023. The references of included studies were reviewed for any additional studies. The mean difference (MD) was chosen as the measure of effect along with its corresponding 95% Confidence Interval (CI). Efficacy and tolerability outcomes were reported as the consecutive days of abstinence and treatment retention, respectively, comparing the group receiving pharmacotherapy to the placebo group. The random effect model was fitted to account for the variations in studies included in the analysis. Heterogeneity was assessed with I-square (I2).

RESULTS: A total of fourteen studies were included in the analysis of which seven were included in the meta-analysis. The duration of the studies ranged from 10-20 weeks with an average age range of 28.7-44.3 years. Cocaine and methamphetamine were the drugs abused. In terms of the consecutive days of abstinence, there was no statistically significant difference between individuals receiving either pharmacotherapy or placebo in addition to CBT [MD = 0.14; 95% CI: -3.08, 3.36; I2=19%] while among CM, individuals receiving pharmacotherapy had statistically significant longer consecutive days of abstinence compared to the placebo [MD= -4.16; 95% CI: -6.46, -1.87; I2=0%]. In terms of treatment retention, participants receiving placebo-augmented CBT had greater treatment retention days compared to those receiving pharmacotherapy-boosted CBT [MD= 14.42; 95% CI: -0.89, 29.74; I2=51%]. High compliance was associated with longer periods of abstinence and treatment retention in both CBT and CM.

CONCLUSIONS: CM with pharmacotherapy yielded longer abstinence than placebo. No significant difference was observed when comparing placebo or pharmacotherapy with CBT in the duration of abstinence.

Code

SA55

Topic

Study Approaches

Topic Subcategory

Literature Review & Synthesis

Disease

Mental Health (including addition), No Additional Disease & Conditions/Specialized Treatment Areas