Improvement in naltrexone treatment compliance with contingency management

Preston, Kenzie L.; Silverman, Kenneth; Umbricht, Annie; DeJesus, Anna; Montoya, Iván D.; Schuster, Charles R.

doi:10.1016/s0376-8716(98)00152-5

Cited by 156 publications

(125 citation statements)

References 23 publications

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“…Given that the primary difficulty associated with naltrexone maintenance in opioid abusers is medication compliance (Kosten and Kleber 1984;Fram et al 1989;Preston et al 1999), a formulation of naltrexone that requires only once-a-month administration has important and exciting treatment implications. Future studies in our laboratory will evaluate the clinical utility of depot naltrexone in the treatment of heroin dependence.…”

Section: Discussionmentioning

confidence: 99%

Depot naltrexone: long-lasting antagonism of the effects of heroin in humans

et al. 2002

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Rationale-Naltrexone, an opioid antagonist, is currently approved as a treatment for heroin dependence. However, naltrexone is generally not well accepted by patients, and medication noncompliance is a difficult obstacle to treatment. A sustained-release form of naltrexone may improve compliance.Objective-The present study was designed to evaluate the time course, safety, and effectiveness of a depot formulation of naltrexone (Depotrex ® ).Methods-Twelve heroin-dependent individuals participated in an 8-week inpatient study. After a 1-week detoxification period, six participants received 192 mg naltrexone base and six participants received 384 mg naltrexone base. For safety, the low dose of depot naltrexone was NIH Public AccessAuthor Manuscript Psychopharmacology (Berl). Author manuscript; available in PMC 2014 July 02. NIH-PA Author Manuscript tested before the high dose. The effects of heroin (0, 6.25, 12.5, 18.75, 25 mg, IV) were evaluated for the next 6 weeks. One dose of heroin was tested per day on Mondays through Fridays, and the entire dose range was tested each week. Active heroin doses were administered in ascending order during the week, while placebo could be administered on any day. Subjective, performance, and physiological effects were measured both before and after heroin administration. The hypotheses were that depot naltrexone would antagonize the effects of heroin, and that the high dose of depot naltrexone would produce a more effective and longer-lasting antagonism than the low dose.Results-The low and high doses of depot naltrexone antagonized heroin-induced subjective ratings for 3 and 5 weeks, respectively. Plasma levels of naltrexone remained above 1 ng/ml for approximately 3 and 4 weeks after administration of 192 mg and 384 mg naltrexone. Other than the initial discomfort associated with the injection of depot naltrexone, there were no untoward side-effects. Conclusions: These results suggest that this depot formulation of naltrexone provides a safe, effective, long-lasting antagonism of the effects of heroin.

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Section: Discussionmentioning

confidence: 99%

Depot naltrexone: long-lasting antagonism of the effects of heroin in humans

et al. 2002

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“…This approach was initially developed for cocaine-dependent outpatients and generated considerable excitement as one of the only replicated effective treatments (psychosocial or pharmacological) for cocaine abuse (Higgins et al, 1991;Higgins, Alessi, & Dantona, 2002). Since then, incentive vouchers have demonstrated efficacy in methadone (Silverman et al, 1996), naltrexone (Preston et al, 1999), opiate detoxification (Bickel, Amass, Higgins, Badger, & Esch, 1997), alcohol (Petry, Martin, Cooney, & Kranzler, 2000), marijuana (Budney, Higgins, Radonovich, & Novy, 2000), and dual diagnosis patients (Shaner et al, 1997;Sigmon, Steingard, Badger, Anthony, & Higgins, 2000). Although the treatment retention and substance reduction rates have not been quite as dramatic as some of the original cocaine studies, participants as a whole who receive incentive vouchers typically do at least twice as well as those who do not receive incentives.…”

Section: Treatment Outcome and Matchingmentioning

confidence: 99%

Millon Clinical Multiaxial Inventory-III Subtypes of Opioid Dependence: Validity and Matching to Behavioral Therapies.

Ball

Nich²,

Rounsaville³

et al. 2004

Journal of Consulting and Clinical Psychology

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The concurrent and predictive validity of 2 different methods of Millon Clinical Multiaxial Inventory-III subtyping (protocol sorting, cluster analysis) was evaluated in 125 recently detoxified opioid-dependent outpatients in a 12-week randomized clinical trial. Participants received naltrexone and relapse prevention group counseling and were assigned to 1 of 3 intervention conditions: (a) no-incentive vouchers, (b) incentive vouchers alone, or (c) incentive vouchers plus relationship counseling. Affective disturbance was the most common Axis I protocol-sorted subtype (66%), antisocial-narcissistic was the most common Axis II subtype (46%), and cluster analysis suggested that a 2-cluster solution (high vs. low psychiatric severity) was optimal. Predictive validity analyses indicated less symptom improvement for the higher problem subtypes, and patient treatment matching analyses indicated that some subtypes had better outcomes in the no-incentive voucher conditions. Addiction subtyping research has identified constellations of personality dimensions (Barnes, Murray, Patton, Bentler, & Anderson, 2000) and psychiatric disorders (Kranzler & Rounsaville, 1998) that are associated with the onset and severity of substance abuse and may have relevance for predicting treatment response. The presence of co-occurring psychiatric disorders seems to indicate a need for specialized or more intensive addiction treatment, and depression, antisocial personality, and general psychiatric symptom severity have been the most commonly investigated problems. Depressed cocaine abusers benefit from cognitive-behavioral coping skills and pharmacotherapy (Carroll et al., 1994), and opiate abusers with greater psychiatric severity improve with more intensive psychosocial programs (McLellan et al., 1983). Antisocial alcohol abusers seem to have better outcomes with coping skills than with interactional approaches (Kadden, Cooney, Getter, & Litt, 1989;Longabaugh et al., 1994), although Kadden, Litt, Cooney, Kabela, and Getter (2001) failed to replicate this effect. Antisocial methadone patients do as well as (Brooner, Kidorf, King, & Stoller, 1998;Silverman et al., 1998), and perhaps better than (Messina, Farabee, & Rawson, 2003), non-antisocial patients when provided with potent behavioral incentives, individual psychotherapy (Woody, McLellan, Luborsky, & O'Brien, 1985), or enhanced psychosocial services (Cacciola, Alterman, & Rutherford, 1995;Cacciola, Rutherford, Alterman, McKay, & Snider, 1996). The current study evaluated psychopathology subtypes derived from the Millon Clinical Multiaxial Inventory-III (MCMI-III;Millon, 1994), the most recent edition of a widely used instrument that measures Axis I and II diagnoses of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) and is also rooted in a biopsychosocial personality theory that may be relevant to the treatments compared in this study. MCMI Psychopathology Subtyping ProceduresThe ability to prospe...

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“…Similarly, Bickel et al (1988-89) reported on a contingency management program for alcohol-dependent patients in which continuation in methadone treatment was contingent upon daily disulfiram ingestion. Several studies have shown efficacy with opioid-dependent patients using voucher incentives to reinforce naltrexone ingestion (Carroll et al, 2001;Carroll et al, 2002;Preston et al, 1999). Contingency management may also be an efficacious intervention for substance-using HIV patients with poor HAART compliance.…”

Section: Introductionmentioning

confidence: 99%

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

Sorensen

Haug

Delucchi

et al. 2007

Drug and Alcohol Dependence

145

136

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This clinical trial evaluated a contingency management intervention designed to improve medication adherence among HIV-positive methadone maintenance patients. After a 4-week baseline observation phase, eligible participants (N = 66) were randomly assigned to: (a) medication coaching sessions every other week to assist with adherence strategies (comparison group) or (b) medication coaching plus voucher reinforcement for opening electronic medication caps on time (voucher group). Baseline adherence (percent doses taken/percent total possible doses) was 51% using electronic measurement, 75% using self-report and 75% using pill count. The intervention was provided for 12 weeks, with a 4-week follow-up. The primary outcome results of the clinical trial indicated effectiveness during the intervention, with significant mean adherence differences between voucher and comparison groups using electronic measurement (78% vs. 56%), pill count (86% vs. 75%), and self-report (87% vs. 69%). Differences between groups faded after vouchers were discontinued. Contingency management shows promise as a strategy to promote antiretroviral medication adherence in this population.

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Improvement in naltrexone treatment compliance with contingency management

Cited by 156 publications

References 23 publications

Depot naltrexone: long-lasting antagonism of the effects of heroin in humans

Depot naltrexone: long-lasting antagonism of the effects of heroin in humans

Millon Clinical Multiaxial Inventory-III Subtypes of Opioid Dependence: Validity and Matching to Behavioral Therapies.

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

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