Increasing opiate abstinence through voucher-based reinforcement therapy.
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.
Silverman
K
K
NIH/NIDA/Intramural Research Program, Clinic Trials Section, Baltimore, MD 21224, USA.
Wong
C J
CJ
Higgins
S T
ST
Brooner
R K
RK
Montoya
I D
ID
Contoreggi
C
C
Umbricht-Schneiter
A
A
Schuster
C R
CR
Preston
K L
KL
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
D008691:Methadone