A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence.
BACKGROUND
This study compared 2 psychosocial approaches for the treatment of cocaine dependence: contingency management (CM) and cognitive-behavioral therapy (CBT).


METHODS
Patients with cocaine dependence who were receiving methadone maintenance treatment (n = 120) were randomly assigned to 1 of 4 conditions: CM, CBT, combined CM and CBT (CBT + CM), or treatment as usual (ie, methadone maintenance treatment program only [MMTP only]) (n = 30 per cell). The CM procedures and CBT materials were comparable to those used in previously published research. The active study period was 16 weeks, requiring 3 clinic visits per week. Participants were evaluated during treatment and at 17, 26, and 52 weeks after admission.


RESULTS
Urinalysis results during the 16-week treatment period show that participants assigned to the 2 groups featuring CM had significantly superior in-treatment urinalysis results, whereas urinalysis results from participants in the CBT group were not significantly different than those from the MMTP-only group. At week 17, self-reported days of cocaine use were significantly reduced from baseline levels for all 3 treatment groups but not for the MMTP-only group. At the 26-week and 52-week follow-up points, CBT participants showed substantial improvement, resulting in equivalent performance with the CM groups as indicated by both urinalysis and self-reported cocaine use data.


CONCLUSIONS
Study findings provide solid evidence of efficacy for CM and CBT. Although the effect of CM is significantly greater during treatment, CBT appears to produce comparable long-term outcomes. There was no evidence of an additive effect for the 2 treatments in the CM + CBT group.
Rawson
Richard A
RA
University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd, Suite 200, Los Angeles, CA 90025, USA. matrixex@ucla.edu
Huber
Alice
A
McCann
Michael
M
Shoptaw
Steven
S
Farabee
David
D
Reiber
Chris
C
Ling
Walter
W
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003042:Cocaine / Q000652:urine; D019970:Cocaine-Related Disorders / Q000534:rehabilitation* / Q000628:therapy* / Q000652:urine; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000534:rehabilitation; D010349:Patient Compliance; D012201:Reward; D015813:Substance Abuse Detection; D016896:Treatment Outcome
D003042:Cocaine; D008691:Methadone