Community reinforcement therapy for cocaine-dependent outpatients.
OBJECTIVE
To examine the contributions of community reinforcement therapy to outcome in the community reinforcement approach (CRA) + vouchers outpatient treatment for cocaine dependence.


METHODS
One hundred cocaine-dependent outpatients were randomly assigned to one of 2 treatment conditions: CRA + vouchers or vouchers only. All patients earned incentives in the form of vouchers exchangeable for retail items contingent on cocaine-free urinalysis results during treatment weeks 1 to 12. Incentives were combined with a 24-week course of CRA therapy designed to promote healthy lifestyle changes in the CRA + vouchers condition, while incentives represented the primary treatment in the vouchers-only condition. Patient drug use and psychosocial functioning were assessed at intake and at least every 3 months for 2 years after treatment entry.


RESULTS
Patients treated with CRA + vouchers were retained better in treatment, used cocaine at a lower frequency during treatment but not follow-up, and reported a lower frequency of drinking to intoxication during treatment and follow-up compared with patients treated with vouchers only. Patients treated with CRA + vouchers also reported a higher frequency of days of paid employment during treatment and the initial 6 months of follow-up, decreased depressive symptoms during treatment only, and fewer hospitalizations and legal problems during follow-up.


CONCLUSIONS
Combining CRA with vouchers had therapeutic effects on substance abuse and psychosocial functioning during treatment and posttreatment follow-up in cocaine-dependent outpatients, although effects on cocaine use appear to be limited to the treatment period.
Higgins
Stephen T
ST
Departments of Psychiatry, Medical Biostatistics, and Psychology, University of Vermont, Burlington, VT 05401, USA. stephen.higgins@uvm.edu
Sigmon
Stacey C
SC
Wong
Conrad J
CJ
Heil
Sarah H
SH
Badger
Gary J
GJ
Donham
Robert
R
Dantona
Robert L
RL
Anthony
Stacey
S
D000328:Adult; D000553:Ambulatory Care; D001521:Behavior Therapy / Q000379:methods*; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012054:Reinforcement, Psychology; D014040:Token Economy; D016896:Treatment Outcome