Abstinence reinforcement maintenance contingency and one-year follow-up.
BACKGROUND
Relapse to drug use is often seen when contingencies designed to reduce drug use are discontinued. This paper reports on a stepdown maintenance contingency and 1-year follow-up in 110 patients who were maintained on methadone (50 or 70 mg/day) and who had completed a contingency management trial targeted to decreasing their opiate use. In the prior study (induction phase, 8 weeks) participants received vouchers for each opiate-negative urine screen or noncontingently.


METHODS
In this study (maintenance phase, 12 weeks), participants were rerandomized to receive vouchers and take-home methadone doses contingent on providing opiate-negative urine specimens (N=55) or noncontingently (N=55). Since participants had been rerandomized from induction-phase contingencies, most study data were analyzed as if from a 2 x 2 (inductionxmaintenance) design. Follow-up interviews were conducted at 3, 6, and 12 months after study participation.


RESULTS
Patients who received the maintenance contingency following an 8-week induction contingency had better outcomes than those who received noncontingent incentives in either the maintenance or induction phases of the trial. Good outcome at follow-up was predicted by enrollment in methadone maintenance after the study. Significantly more participants in the maintenance contingency group transferred directly to another methadone program.


CONCLUSIONS
These findings support the therapeutic value of extending the duration of contingency management and long-term methadone maintenance.
Preston
Kenzie L
KL
National Institute on Drug Abuse (NIDA) Intramural Research Program, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA. kpreston@intra.nida.nih.gov
Umbricht
Annie
A
Epstein
David H
DH
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation* / Q000652:urine; D012054:Reinforcement, Psychology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D008691:Methadone