Reinforcement-based outpatient treatment for opiate and cocaine abusers.
A reinforcement-based intensive outpatient treatment was delivered to 37 recently detoxified, inner city, heroin and/or cocaine abusers who did not want methadone treatment. Attendance was scheduled and urine collected daily for the first 2 weeks, four times weekly for the next 2 weeks, and then thrice weekly for the final 8 weeks. As attendance incentives, patients received transportation assistance (bus tokens), and $28-$30 per week in vouchers to be spent on activities/items chosen and agreed upon with their counselor. As abstinence incentives, patients received weekend supported recreational activities, lunches, $42-$45 per week in vouchers, and rent or utilities payment ($150 over 4 weeks). Total potential earnings was $1,435 per patient; actual mean earnings was $583. Forty-three percent (n=16) completed 10 or more weeks of treatment. These 16 long-stay patients submitted 92% (SD=19) opiate- and cocaine-negative urines during their enrollment compared with 56% (SD=42) drug-negative urines submitted by 21 drop-outs, F(1,35)=9.99, p=0.003. Overall, 32% of clients became employed during their treatment episode; 94% of long-stay patients were employed at the end of their treatment episode. Patients who were drug-positive at intake were highly likely to drop out. Treatment outcomes compare favorably with those reported in the literature for outpatient nonmethadone treatment of opiate and cocaine abusers. Continued evaluation of this new treatment appears warranted.
Cornerstone Treatment Research Clinic, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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Katz
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Gruber
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Chutuape
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Stitzer
D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D001521:Behavior Therapy / Q000379:methods*; D019970:Cocaine-Related Disorders / Q000628:therapy* / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000628:therapy* / Q000652:urine; D010045:Outpatients / Q000523:psychology; D010352:Patient Dropouts / Q000523:psychology* / Q000706:statistics & numerical data; D012054:Reinforcement, Psychology; D015813:Substance Abuse Detection / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome