title: Effects of reducing contingency management values on heroin and cocaine use for buprenorphine- and desipramine-treated patients.
abstract: OBJECTIVE
  During 3 months where contingency management (CM) had an escalating value for each consecutive drug-free urine (escalating CM), cocaine- and heroin-abusing patients significantly increased drug-free urines. The 'escalating CM' was eliminated during months 4-6 to assess any reduction in drug-free urines.
  
  
  METHODS
  Patients who completed a 3-month, randomized, double-blind, trial evaluating CM versus non-CM and desipramine (DMI) versus placebo, had an 'escalating CM' eliminated during months 4-6. The CM and non-CM groups were compared using thrice-weekly urine samples.
  
  
  METHODS
  Out-patient buprenorphine maintenance for 6 months.
  
  
  METHODS
  All 75 of the 160 original study patients who completed month 3 of the clinical trial.
  
  
  METHODS
  The 'escalating CM' was eliminated for all 3 months and during months 5 and 6 the response requirement was also increased to two and then three consecutive drug-free urines in order to obtain a voucher.
  
  
  METHODS
  Urine toxicology for opiates and cocaine.
  
  
  RESULTS
  After eliminating the 'escalating CM', the CM group showed a decline in combined opioid- and cocaine-free urines. This decline within the CM group was greater in those treated with DMI than placebo.
  
  
  CONCLUSIONS
  Buprenorphine with DMI maintained drug abstinence after eliminating the 'escalating CM', but not after increasing the response requirement, suggesting the need for more intensive psychosocial interventions during CM.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, VA New England MIRECC, West Haven, CT 06516, USA. thomas.kosten@yale.edu
authors.forename: Thomas
authors.initials: T
authors.lastname: Kosten
authors.forename: James
authors.initials: J
authors.lastname: Poling
authors.forename: Alison
authors.initials: A
authors.lastname: Oliveto
mesh_terms: D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D032763:Behavior Control / Q000379:methods*; D002047:Buprenorphine / Q000627:therapeutic use; D019970:Cocaine-Related Disorders / Q000188:drug therapy* / Q000652:urine; D003891:Desipramine / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D009294:Narcotics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000652:urine; D014040:Token Economy; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D009294:Narcotics; D002047:Buprenorphine; D003891:Desipramine