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

Abstract

Although contingency management (CM) is effective in promoting abstinence and treatment retention among crack cocaine users who meet the criteria for cocaine dependence, less is known about its off-target effects. In this secondary analysis, we evaluated the impact of CM on depressive and anxiety symptoms in a sample of cocaine-dependent individuals under treatment. Sixty-five crack cocaine users who met the criteria for cocaine dependence were randomly assigned to receive 12 weeks of standard treatment alone (STA; n = 32) or 12 weeks of standard treatment plus CM (STCM; n = 33). The outcome measures of the secondary analysis were depressive and anxiety symptoms assessed with the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). At baseline, 59 (90.8%) of the participants reported at least mild depressive symptoms and 47 (72.5%) reported at least mild anxiety symptoms. The mean BDI-II (24.5 ± 12.1) and BAI (20.7 ± 13.5) scores in the sample as a whole was moderate. After treatment, the reported levels of depressive symptoms (β = −9.6, p < .05) and anxiety symptoms (β = −9.9, p <.05) were lower among the individuals receiving STCM than among those receiving STA. This study provides evidence that an STCM intervention targeting crack cocaine abstinence also produces significant reductions in depressive and anxiety symptoms. This low cost intervention also demonstrated significant promise and optimization potential for crack cocaine users in a setting of scarce resources and high mental health comorbidity.

Sociodemographic Characteristics, Patterns of Crack Use, Concomitant Substance Use Disorders, and Psychiatric Symptomatology in Treatment-Seeking Crack-Dependent Individuals in Brazil

“…The high quantity and frequency of crack use reported by the participants, together with the fact that most of them reported having used crack continuously for more than 10 years and the evidence of numerous failed treatment attempts, highlight the severe, compulsive, and chronic nature of this disorder. Those findings also indicate the lack of efficacy of the existing centers in treating crack dependence and advocate for the need to incorporate evidence-based treatments such as contingency management (Miguel et al 2016 Miguel et al 2017).…”

Short and long-term improvements in psychiatric symptomatology to validate clinically meaningful treatment outcomes for cocaine use disorders

“…Co-occurring psychiatric disorders are highly prevalent among individuals with CUD and represent a severe burden with direct impact on how individuals feel and function in their daily lives (Conner et al, 2008;Conway et al, 2006;Ford et al, 2009;Grant et al, 2004). Nonetheless, only a few treatment trials for CUD have found improvements in psychiatric symptoms (Miguel et al, 2017;Petry et al, 2013). This is possibly due to the fact that most treatment trials for CUD do not directly target psychiatric symptoms and thus treatment effects for this outcome tend to be less robust.…”

Contingency Management Banking

“…Recently, our group published the first Brazilian CM treatment trial for CUD using the classic vouchers-based, escalating reinforcement type of approach for the application of CM (Miguel et al, 2016(Miguel et al, , 2017(Miguel et al, , 2018(Miguel et al, , 2019. Despite our positive results, we observed specific components of the CM approach that could be generating unnecessary costs and limiting the efficacy and treatment engagement potential of CM.…”