Introduction: Individuals with traumatic brain injury (TBI) experience relatively high rates of co-occurring substance use disorders and difficulty with treatment engagement, which may lead to poor long-term outcomes. Evidence in non-TBI populations indicates that contingency management, a behavioural intervention that reinforces positive behaviour change, may improve treatment engagement and achievement of substance use goals.
Purpose: This systematic review aimed to examine the use and effectiveness of contingency management interventions for individuals with TBI who use substances.
Method: A pre-registered review (Prospero: CRD42024564646) implemented the PRISMA 2020 Guidelines to systematically search both peer-reviewed and grey literature in 17 databases, found across six interfaces, and three Advanced Google searches, from inception to July 2024. Covidence was used to screen for eligible studies, guided by the PICO framework, by two independent reviewers.
Results: The search returned results for 533 records for title and abstract screening. Of which, 22 reports were included for full text screening. The systematic search identified three studies meeting criteria for data extraction and quality appraisal: Two randomised controlled trials and one case series underwent data extraction and quality appraisal. Reinforcement targeted behaviours related to treatment engagement, attendance, and substance use abstinence. Financial and voucher-based contingencies were delivered on single, variable, and standard pay rates for adults with TBI who used various substances, including alcohol, cannabis, cocaine, and cigarettes (tobacco). Reporting of baseline characteristics was inconsistent between studies.
Conclusion: There is a dearth of evidence on contingency management for adults with TBI who use substances. There is preliminary support for contingency management to increase attendance in substance use treatment post-TBI. However, findings were inconclusive for substance use reduction for TBI populations. Further research is needed to investigate contingency management protocols, which consider substance use severity and support needs, across various target behaviours.