A behavioral approach to achieving initial cocaine abstinence

Higgins, Stephen T.; Delaney, Dawn; Budney, Alan J.; Bickel, Warren K.; Hughes, John R.; Foerg, Florian E.; Fenwick, James W.

doi:10.1176/ajp.148.9.1218

Cited by 500 publications

(106 citation statements)

References 16 publications

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“…CM approaches attempt to change the user’s environment such that ( a ) substance use and abstinence are readily detected, ( b ) abstinence is readily reinforced, ( c ) substance use results in a loss of reinforcement, and ( d ) the density of reinforcement derived from substance-free sources is increased to compete with the reinforcing effects of substance use (Higgins et al 1991). Thus, one of the active mechanisms of CM is the increased costs (loss of reinforcement) associated with the detection of substance use.…”

Section: The Repair Of Reinforcer Pathologiesmentioning

confidence: 99%

The Behavioral Economics of Substance Use Disorders: Reinforcement Pathologies and Their Repair

Bickel

Johnson

Koffarnus

et al. 2014

Annu. Rev. Clin. Psychol.

573

529

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The field of behavioral economics has made important inroads into the understanding of substance use disorders through the concept of reinforcer pathology. Reinforcer pathology refers to the joint effects of (a) the persistently high valuation of a reinforcer, broadly defined to include tangible commodities and experiences, and/or (b) the excessive preference for the immediate acquisition or consumption of a commodity despite long-term negative outcomes. From this perspective, reinforcer pathology results from the recursive interactions of endogenous person-level variables and exogenous environment-level factors. The current review describes the basic principles of behavioral economics that are central to reinforcer pathology, the processes that engender reinforcer pathology, and the approaches and procedures that can repair reinforcement pathologies. The overall goal of this review is to present a new understanding of substance use disorders as viewed by recent advances in behavioral economics.

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Section: The Repair Of Reinforcer Pathologiesmentioning

confidence: 99%

The Behavioral Economics of Substance Use Disorders: Reinforcement Pathologies and Their Repair

Bickel

Johnson

Koffarnus

et al. 2014

Annu. Rev. Clin. Psychol.

573

529

View full text Add to dashboard Cite

show abstract

“…Contingency management interventions are rooted in research that suggests drug addiction is operant behavior that is maintained and modifiable by its consequences and should be modifiable through the strategic use of alternative reinforcement (Bigelow & Silverman, 1999). Based on these principles, Higgins and colleagues developed voucher-based reinforcement intervention in which patients receive monetary vouchers exchangeable for goods and services for providing drug-free urine samples (Higgins et al, 1991). Voucher-based reinforcement can increase abstinence from a wide range of drugs (Lussier, Heil, Mongeon, Badger, & Higgins, 2006) and has been identified as a highly effective behavioral treatment for drug addiction (Castells et al, 2009; Dutra et al, 2008; Knapp et al, 2007; Pilling, Strang, Gerada, & NICE, 2007).…”

Section: Introductionmentioning

confidence: 99%

A therapeutic workplace for the long-term treatment of drug addiction and unemployment: Eight-year outcomes of a social business intervention

Aklin

Wong

Hampton

et al. 2014

Journal of Substance Abuse Treatment

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This study evaluated the long-term effects of a Therapeutic Workplace social business on drug abstinence and employment. Pregnant and postpartum women (N=40) enrolled in methadone treatment were randomly assigned to a Therapeutic Workplace or Usual Care Control group. Therapeutic Workplace participants could work weekdays in training and then as employees of a social business, but were required to provide drug-free urine samples to work and maintain maximum pay. Three-year outcomes were reported previously. This paper reports 4- to 8- year outcomes. During year 4 when the business was open, Therapeutic Workplace participants provided significantly more cocaine- and opiate-negative urine samples than controls; reported more days employed, higher employment income, and less money spent on drugs. During the 3 years after the business closed, Therapeutic Workplace participants only reported higher income than controls. A Therapeutic Workplace social business can maintain long-term abstinence and employment, but additional intervention may be required to sustain effects.

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“…For example, this schedule of reinforcement has promoted cocaine abstinence initiation in 80% of patients, retained 60% of patients for 6 months or more, and significantly improved rates of sustained abstinence compared to usual care (Higgins et al, 1991, 1993). Studies have reported that 75% to 85% of patients achieved at least 3 weeks of continuous abstinence (e.g., Higgins et al, 1993, 1994).…”

Section: Introductionmentioning

confidence: 99%

Contingency management for cocaine treatment: Cash vs. vouchers

Festinger

Dugosh

Kirby

et al. 2014

Journal of Substance Abuse Treatment

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The efficacy of contingency management (CM) for treating drug abuse is well supported. The most widely used form of CM is voucher-based reinforcement therapy (VBRT), where clients receive an escalating schedule of vouchers that can be redeemed for goods and services for meeting treatment goals. Though generally rejected due to concerns about potential harms to drug using participants, research suggests that cash may be a more effective reinforcer. This three-group randomized trial compared the efficacy of cash-based reinforcement therapy (CBRT) to VBRT and a non-CM condition on cocaine abstinence and treatment attendance; and examined whether CBRT resulted in greater levels of harm than VBRT. Findings indicated that the CBRT was as effective as VBRT when compared to the non-CM condition and that it did not increase rates of drug use, cravings, or high-risk behaviors. Future research should examine potential cost savings associated with a cash-based CM approach as this could have important implications for the wider adoption of the CM model.

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A behavioral approach to achieving initial cocaine abstinence

Abstract: 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.

Cited by 500 publications

References 16 publications

The Behavioral Economics of Substance Use Disorders: Reinforcement Pathologies and Their Repair

The Behavioral Economics of Substance Use Disorders: Reinforcement Pathologies and Their Repair

A therapeutic workplace for the long-term treatment of drug addiction and unemployment: Eight-year outcomes of a social business intervention

Contingency management for cocaine treatment: Cash vs. vouchers

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