title: Community reinforcement approach for combined opioid and cocaine dependence. Patterns of engagement in alternate activities.
abstract: We compared outcomes for agonist-maintained patients with combined opioid and cocaine dependence who were treated in an earlier clinical trial with group drug counseling (DC; n = 57) or in a current trial with the Community Reinforcement Approach (CRA; n = 60). The association between engagement in nondrug-related activities and abstinence was also evaluated. There were no significant differences between the treatments in retention or drug use. The total number of hours and average hours per week engaged in nondrug-related activities was significantly higher for CRA-treated patients who achieved abstinence from opioids, cocaine, or both combined than for those who never achieved abstinence. Although CRA was not more effective overall than DC, the finding that engagement in reinforcing community activities unrelated to drug use (e.g., planned pleasurable events or parenting activities) was associated with abstinence suggests that the planning and reinforcement of specific nondrug-related social, vocational, and recreational activities is a crucial component of CRA.
authors.affiliation: CMHC/SAC, Room S-205, 34 Park Street, New Haven, CT 06519, USA. richard.schottenfeld@yale.edu
authors.forename: R S
authors.initials: RS
authors.lastname: Schottenfeld
authors.forename: M V
authors.initials: MV
authors.lastname: Pantalon
authors.forename: M C
authors.initials: MC
authors.lastname: Chawarski
authors.forename: J
authors.initials: J
authors.lastname: Pakes
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019970:Cocaine-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D019058:Community Networks / Q000706:statistics & numerical data*; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D012008:Recurrence; D012944:Social Support; D012960:Socioenvironmental Therapy / Q000379:methods; D013695:Temperance; D016896:Treatment Outcome; D014481:United States
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone