title: Reinforcement-based intensive outpatient treatment for inner city opiate abusers: a short-term evaluation.
abstract: We evaluated 3-month outcomes for reinforcement-based intensive outpatient treatment (RBT), a new relapse prevention behavior therapy for inner city opiate abusers. The therapy provides abstinence-contingent partial support of housing, food and recreational activities, abstinence-contingent access to social skills and job finding group therapy and non-contingent individual counseling, all in the context of a day treatment program. Heroin abusers (n = 52), contacted at a 3-day detoxification unit, were randomly assigned to RBT (n = 28) or referred to community treatment resources (n = 24) after a staff escort from the detoxification unit. For RBT patients, treatment began on the day of discharge; 61% received partial rent support in a recovery house based on the need for drug-free housing; the remainder were eligible for partial support of utility payments where they lived. Abstinence-based contingencies were in effect for 1 month with three times per week counseling available for an additional 2 months. One month after detoxification, 61% of RBT versus 17% of referral patients were enrolled in outpatient treatment (P < 0.01); RBT patients were significantly less likely than controls to have returned to any drug use; and 50% of RBT versus 21% of controls reported 30 days of abstinence from heroin and cocaine with confirmatory negative urine (P < 0.05). RBT patients had significantly lower scores on the Beck Depression Inventory at 1 month (M = 9.0 versus 17.6 for controls; P < 0.05) and showed evidence of less alcohol use and higher rates of employment. These results establish the short-term efficacy for RBT and support continued development and evaluation of this new outpatient behavioral treatment.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
authors.forename: K
authors.initials: K
authors.lastname: Gruber
authors.forename: M A
authors.initials: MA
authors.lastname: Chutuape
authors.forename: M L
authors.initials: ML
authors.lastname: Stitzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000553:Ambulatory Care; D015142:Baltimore; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D005260:Female; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012050:Rehabilitation, Vocational; D012054:Reinforcement, Psychology; D014040:Token Economy; D014505:Urban Population