Contingency management to enhance naltrexone treatment of opioid dependence: a randomized clinical trial of reinforcement magnitude.
Fifty-five detoxified opioid-dependent individuals were randomly assigned to 1 of 3 treatments delivered over 12 weeks: standard naltrexone maintenance, standard naltrexone plus low-value contingency management (CM), or standard naltrexone plus high-value CM. Results suggest that (a) assignment to either CM condition was associated with significant reductions in opioid use over time compared with standard naltrexone treatment; (b) contrasts of high- versus low-value reinforcement magnitude were not significant, suggesting no relative benefit of higher over lower value incentives in this population; (c) participants assigned to either CM group reported significant reductions in readiness to change compared with participants assigned to standard naltrexone treatment. These findings suggest that targeted behavioral therapies can play a substantial role in broadening the utility of available pharmacotherapies.
Carroll
Kathleen M
KM
Department of Psychiatry, Division of Substance Abuse, Yale University School of Medicine, West Haven, Connecticut 06516, USA. kathleen.carroll@yale.edu
Sinha
Rajita
R
Nich
Charla
C
Babuscio
Theresa
T
Rounsaville
Bruce J
BJ
D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D010349:Patient Compliance; D012309:Risk-Taking; D012919:Social Behavior; D016896:Treatment Outcome
D009292:Narcotic Antagonists; D009271:Naltrexone