Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence: efficacy of contingency management and significant other involvement.
BACKGROUND
Contingency management (CM) and significant other involvement (SO) were evaluated as strategies to enhance treatment retention, medication compliance, and outcome for naltrexone treatment of opioid dependence.


METHODS
One hundred twenty-seven recently detoxified opioid-dependent individuals were randomly assigned to 1 of 3 conditions delivered for 12 weeks: (1) standard naltrexone treatment, given 3 times a week; (2) naltrexone treatment plus contingency management (CM), with delivery of vouchers contingent on naltrexone compliance and drug-free urine specimens; or (3) naltrexone treatment, CM, plus significant other involvement (SO), where a family member was invited to participate in up to 6 family counseling sessions. Principal outcomes were retention in treatment, compliance with naltrexone therapy, and number of drug-free urine specimens.


RESULTS
First, CM was associated with significant improvements in treatment retention (7.4 vs 5.6 weeks; P =.05) and in reduction in opioid use (19 vs 14 opioid-free urine specimens; P =.04) compared with standard naltrexone treatment. Second, assignment to SO did not significantly improve retention, compliance, or substance abuse outcomes compared with CM. Significant effects for the SO condition over CM on retention, compliance, and drug use outcomes were seen only for the subgroup who attended at least 1 family counseling session. The SO condition was associated with significant (P =.02) improvements in family functioning.


CONCLUSIONS
Behavioral therapies, such as CM, can be targeted to address weaknesses of specific pharmacotherapies, such as noncompliance, and thus can play a substantial role in broadening the utility of available pharmacotherapies.
Carroll
K M
KM
Department of Psychiatry, Yale University School of Medicine, VA CT Healthcare System, 950 Campbell Ave (151D), West Haven, CT 06516, USA. kathleen.carroll@yale.edu
Ball
S A
SA
Nich
C
C
O'Connor
P G
PG
Eagan
D A
DA
Frankforter
T L
TL
Triffleman
E G
EG
Shi
J
J
Rounsaville
B J
BJ
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005196:Family Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000628:therapy*; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012201:Reward; D015813:Substance Abuse Detection / Q000706:statistics & numerical data; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000706:statistics & numerical data
D009292:Narcotic Antagonists; D009271:Naltrexone