A randomized trial of long-term reinforcement of cocaine abstinence in methadone-maintained patients who inject drugs.
This study determined whether long-term abstinence reinforcement could maintain cocaine abstinence throughout a year long period. Patients who injected drugs and used cocaine during methadone treatment (n = 78) were randomly assigned to 1 of 2 abstinence-reinforcement groups or to a usual care control group. Participants in the 2 abstinence-reinforcement groups could earn take-home methadone doses for providing opiate- and cocaine-free urine samples; participants in 1 of those groups also could earn 5,800 US dollars in vouchers for providing cocaine-free urine samples over 52 weeks. Both abstinence-reinforcement interventions increased cocaine abstinence, but the addition of the voucher intervention resulted in the largest and most sustained abstinence. Therefore, voucher-based reinforcement of cocaine abstinence in methadone patients can be a highly effective maintenance intervention.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. ksilverm@jhmi.edu.
Kenneth
K
Silverman
Elias
E
Robles
Timothy
T
Mudric
George E
GE
Bigelow
Maxine L
ML
Stitzer
D000293:Adolescent; D000328:Adult; D019970:Cocaine-Related Disorders / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use*; D012054:Reinforcement, Psychology; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*; D013997:Time Factors
D009294:Narcotics; D008691:Methadone