title: Increasing opiate abstinence through voucher-based reinforcement therapy.
abstract: Heroin dependence remains a serious and costly public health problem, even in patients receiving methadone maintenance treatment. This study used a within-subject reversal design to assess the effectiveness of voucher-based abstinence reinforcement in reducing opiate use in patients receiving methadone maintenance treatment in an inner-city program. Throughout the study subjects received standard methadone maintenance treatment involving methadone, counseling, and urine monitoring (three times per week). Thirteen patients who continued to use opiates regularly during a 5-week baseline period were exposed to a 12-week program in which they received a voucher for each opiate-free urine sample provided: the vouchers had monetary values that increased as the number of consecutive opiate-free urines increased. Subjects continued receiving standard methadone maintenance for 8 weeks after discontinuation of the voucher program (return-to-baseline). Tukey's posthoc contrasts showed that the percentage of urine specimens that were positive for opiates decreased significantly when the voucher program was instituted. (P < or = 0.01) and then increased significantly when the voucher program was discontinued during the return-to-baseline condition (P < or = 0.01). Rates of opiate positive urines in the return-to-baseline condition remained significantly below the rates observed in the initial baseline period (P < or = 0.01). Overall, the study shows that voucher-based reinforcement contingencies can decrease opiate use in heroin dependent patients receiving methadone maintenance treatment.
authors.affiliation: NIH/NIDA/Intramural Research Program, Clinic Trials Section, Baltimore, MD 21224, USA.
authors.forename: K
authors.initials: K
authors.lastname: Silverman
authors.forename: C J
authors.initials: CJ
authors.lastname: Wong
authors.forename: S T
authors.initials: ST
authors.lastname: Higgins
authors.forename: R K
authors.initials: RK
authors.lastname: Brooner
authors.forename: I D
authors.initials: ID
authors.lastname: Montoya
authors.forename: C
authors.initials: C
authors.lastname: Contoreggi
authors.forename: A
authors.initials: A
authors.lastname: Umbricht-Schneiter
authors.forename: C R
authors.initials: CR
authors.lastname: Schuster
authors.forename: K L
authors.initials: KL
authors.lastname: Preston
mesh_terms: D000328:Adult; D005260:Female; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology; D015813:Substance Abuse Detection; D015819:Substance Abuse, Intravenous / Q000523:psychology / Q000534:rehabilitation*; D014040:Token Economy; D016896:Treatment Outcome
chemical_list: D008691:Methadone