A Randomized Trial of Long-Term Reinforcement of Cocaine Abstinence in Methadone-Maintained Patients Who Inject Drugs.

Abstract

This study determined whether long-term abstinence reinforcement could maintain cocaine abstinence throughout a year long period. Patients who injected drugs and used cocaine during methadone treatment (n = 78) were randomly assigned to 1 of 2 abstinence-reinforcement groups or to a usual care control group. Participants in the 2 abstinence-reinforcement groups could earn take-home methadone doses for providing opiate- and cocaine-free urine samples; participants in 1 of those groups also could earn 5,800 US dollars in vouchers for providing cocaine-free urine samples over 52 weeks. Both abstinence-reinforcement interventions increased cocaine abstinence, but the addition of the voucher intervention resulted in the largest and most sustained abstinence. Therefore, voucher-based reinforcement of cocaine abstinence in methadone patients can be a highly effective maintenance intervention.

Voucher reinforcement improves medication adherence in HIV-positive methadone patients: A randomized trial

“…Voucher reinforcement was associated with a difference in opening of medication caps from 56% to 78%. Thus this study builds upon randomized trials of voucher reinforcement aimed at decreasing drug use (Jones et al, 2001;Silverman et al, 1996a;Silverman et al, 1996b;Silverman et al, 2004) as well as the application of behavioral approaches to improve adherence to HIV medication regimens (Rigsby et al, 2000). Specifically, this study extends these findings, indicating that voucher reinforcement can be applied successfully to reinforcing adherence to medications in HIV-positive methadone maintenance patients and providing a clinical trial in addition to Rigsby et al (2000) indicating the utility of contingency management in promoting adherence to HAART medications.…”

“…In short, the voucher intervention did not build long-lasting adherence habits that endured without reinforcement, and the results may speak to the desirability of a longer intervention. Recently Silverman et al (2004) demonstrated that reinforcing contingencies can retain their effectiveness over periods as long as a year if continuously applied. The contingencies used in the present study may have greater effectiveness in a longer trial and more opportunity to improve participants' health.…”

“…Initially the value of the vouchers is low, but the value increases with the number of consecutive drug-free urine specimens. This approach has been successful with methadone maintenance patients in encouraging sustained abstinence from cocaine (Silverman et al, 1996a;Silverman et al, 2004) and opiates (Silverman et al, 1996b) as well as increasing full-day attendance at treatment (Jones et al, 2001). …”

Self-report of illicit benzodiazepine use on the Addiction Severity Index predicts treatment outcome

“…CM has been particularly useful in decreasing the use of cocaine in patients in methadone maintenance (Piotrowski et al, 1999;Silverman et al, 1998;Silverman et al, 2004). Although methadone maintenance is a very effective treatment for opioid dependence, continued use of non-opioid drugs during treatment is a significant problem for many patients (Bleich et al, 2002;Drake et al, 1993;Stitzer et al, 1992).…”

Contingency management: Why it pays to quit

“…In one experiment 3 , she divided cocaine users on a methadone treatment programme into three groups: one group received take-home methadone privileges for negative test results; a second received the takehome privileges plus vouchers totalling up to $5,800 over 52 weeks; and a third followed the normal protocol of taking methadone at the clinic. Both sets of people with the takehome privileges submitted three times more drug-negative urine samples than the normal maintenance group over a one-year period.…”