title: Use of methadone take-home contingencies with persistent opiate and cocaine abusers.
abstract: This study investigated conditions under which methadone patients with urinalysis evidence of persistent multiple drug abuse would respond to take-home incentive procedures. Study subjects submitted > or = 80% opiate and/or cocaine positive urines during a 5-week baseline period (M, W, F urine testing) while maintained on 60 mg methadone. Doses were raised to 80-100 mg methadone under blind conditions and subjects were randomly assigned to receive methadone take-home doses under one of three conditions: (a) earn a 1-day take-home privilege for each opiate and cocaine-free test delivered (daily contingent condition), (b) three negative test results required for the first take-home privilege, with each subsequent negative test earning one take-home dose; a positive test reset the contingency back to three again (weekly contingent condition), or (c) a control group that did not receive take-home privileges (no take-home control). Five of 21 subjects (24%) assigned to a contingent take-home intervention (2 from condition a, 3 from condition b) showed marked reductions in drug use and delivered 4 or more consecutive weeks of drug-free urines during a 16-week intervention. No subject in the control group met these criteria. Percent positive urines decreased by 14% and 18% from baseline in daily and weekly contingency groups, respectively, compared to a decline of 2% in the no take-home control group (planned contrast of means p < .07 and .05, respectively). Thus, the study demonstrated that take-home incentives can be effective for reducing during-treatment use of opiates and cocaine in methadone patients with a poor prognosis related to their persistent multiple drug use.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. chutuape@welchlink.welch.jhu.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Chutuape
authors.forename: K
authors.initials: K
authors.lastname: Silverman
authors.forename: M L
authors.initials: ML
authors.lastname: Stitzer
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000704:Analysis of Variance; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000534:rehabilitation* / Q000652:urine; D005260:Female; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation* / Q000652:urine; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008991:Monitoring, Physiologic; D012201:Reward; D016037:Single-Blind Method
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone