Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users in Brazil: A randomized controlled trial.

Abstract

BACKGROUND Crack cocaine dependence has become a severe public health problem in Brazil, and current psychosocial approaches to this problem have shown little or no effectiveness. Although contingency management is among the most effective behavioral treatments for substance use disorders, it has never been applied in the treatment of crack cocaine-dependent individuals in Brazil. AIMS To evaluate the efficacy of incorporating contingency management into standard outpatient treatment for crack cocaine dependence, as well as the impact that doing so has on treatment attendance, retention in treatment, maintenance of abstinence, and the frequency of substance use. METHODS We evaluated 65 treatment-seeking, crack cocaine-dependent individuals, randomized to receive 12 weeks of standard treatment plus contingency management (STCM; n = 33) or 12 weeks of standard treatment alone (STA; n = 32). Those in the STCM group received monetary incentives for being abstinent, earning up to US$235.50 if they remained abstinent throughout the entire treatment period. RESULTS The STCM group participants attended a mean of 19.5 (SD = 14.9) treatment sessions, compared with 3.7 (SD = 5.9) for the STA group participants (p < 0.01). Those in the STCM group were 3.8, 4.6, and 68.9 times more likely to be retained in treatment at weeks 4, 8, and 12 than were those in the STA group. The likelihood of detecting 4, 8, and 12 weeks of continuous abstinence was 17.7, 9.9, and 18.6 times higher in the STCM group than in the STA group (p < 0.05). Compared to the STA group, the STCM group submitted a significantly higher proportion of crack cocaine, THC, and alcohol negative samples (p < 0.001) when all expected samples were included in the denominator, but not when only submitted samples were considered. The average monthly cost/participant for incentives was $29.00. CONCLUSIONS Contingency management showed efficacy in a sample of Brazilian crack cocaine users. The intervention holds promise for broader application in international settings.

Contingency management treatment for substance use disorders: How far has it come, and where does it need to go?

“…In the United Kingdom, it is included in the National Institute for Health and Clinical Excellence guidelines (NICE, 2007). It has also been successfully applied in other European countries as well as Brazil and China (Chen et al, 2013; Etter & Schmid 2016; Hser et al, 2011; Miguel et al, 2016; Petitjean et al, 2014; Secades-Villa, Garcia-Rodriguez, & Fernandez-Hermida 2015; Wang et al, 2014). …”

Contingency management targeting abstinence is effective in reducing depressive and anxiety symptoms among crack cocaine-dependent individuals.

“…The present study utilized data collected in a randomized clinical trial designed to evaluate the effect of CM on crack cocaine use, the duration of abstinence from crack cocaine, treatment attendance, and treatment retention in a population of treatment-seeking crack cocaine-dependent individuals in the city of Sao Paulo (Miguel et al, 2016). …”

“…Vouchers could be exchanged for any goods available in the surrounding community, with the exceptions of tobacco products and alcohol. A full description of the methodology employed is available elsewhere (Miguel et al, 2016). …”

Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users with a previous history of poor treatment response: a crossover trial

“…Recently, our group conducted the first randomized clinical trial (RCT) of CM for the treatment of CUD in Brazil (Miguel et al, 2016). We observed that, in comparison with the participants receiving usual care (control condition), those treated with CM had a lower frequency of cocaine use, achieved longer periods of continuous cocaine abstinence, and were more likely to be retained until the end of the treatment.…”