The behavioral treatment described in this paper offers promise as an effective intervention for achieving initial cocaine abstinence. A randomized trial is underway to assess the generality of these findings.

Two males diagnosed with cocaine dependence received a behavioral intervention comprised of contingency management and the community reinforcement approach. During the initial phase of treatment, reinforcement was delivered contingent on submitting cocaine-free urine specimens. The community reinforcement approach involved two behavior therapy sessions each week. Almost complete cocaine abstinence was achieved, but regular marijuana use continued. During a second phase, reinforcement magnitude was reduced, but remained contingent on submitting cocaine-free specimens. Behavior therapy was reduced to once per week. Cocaine abstinence and regular marijuana use continued. Next, reinforcement was delivered contingent on submitting cocaine-and marijuanafree specimens. This modified contingency resulted in an abrupt increase in marijuana abstinence and maintenance of cocaine abstinence. One-and 5-month follow-ups indicated that cocaine abstinence continued, but marijuana smoking resumed. These results indicate that the behavioral intervention was efficacious in achieving abstinence from cocaine and marijuana; maintenance, however, was achieved for cocaine only.

The compulsive and deeply disturbing character of self‐injurious behavior (SIB) makes it one of the most difficult behavior problems to understand scientifically and treat clinically. We review evidence implicating endogenous opioid peptides and the neurotransmitter dopamine in SIB. Next, we describe similarities between the self‐administration of cocaine and morphine by laboratory animals and self‐injury by people with mental retardation. We discuss shared behavioral and neurochemical properties that suggest common mechanisms that may be responsible for both the persistent, damaging behavior patterns characteristic of some forms of SIB and the addictive self‐administration of cocaine and morphine. Multifaceted treatment approaches are explored, based on a better understanding of underlying mechanisms. © 1995 Wiley‐Liss, Inc.

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