Reinforcement-based therapy: 12-month evaluation of an outpatient drug-free treatment for heroin abusers.
This controlled study examined the efficacy of reinforcement-based therapy (RBT) for producing enhanced abstinence outcomes over 12 months in opioid-dependent patients exiting a brief residential detoxification. Patients were randomly assigned upon completing their medically managed taper (i.e., detoxification) to RBT (N=66) or usual care (N=64) referral to community treatment programs. The 6-month RBT program offered an array of abstinence-based incentives including rent payment for recovery housing, program-led recreational activities and skills training for procuring employment. RBT produced significantly higher self-report and urinalysis-confirmed rates of abstinence from opioids and cocaine relative to usual care at 1 (42% versus 15%) and 3 (38% versus 17%) months during treatment but not at 6 or 12 months after enrollment. The RBT but not the usual care group showed significant increases in the number of days worked and the amount of legal income earned at 3, 6 and 12 months. The results of this randomized study suggest that an intensive reinforcement-based therapy that includes abstinence-based recovery housing is a promising approach; however, further research is needed to determine the role of treatment intensity and the specific efficacy of RBT's component parts.
Cornerstone Treatment Research Clinic, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Cornerstone D-3-E, 4940 Eastern Avenue, Baltimore, MD 21224, USA. hendreejones@yahoo.com
Hendree E
HE
Jones
Conrad J
CJ
Wong
Michelle
M
Tuten
Maxine L
ML
Stitzer
D000328:Adult; D000359:Aftercare; D000553:Ambulatory Care; D015142:Baltimore; D001521:Behavior Therapy; D005260:Female; D003932:Heroin / Q000652:urine; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000628:therapy* / Q000652:urine; D010043:Outcome and Process Assessment, Health Care; D012054:Reinforcement, Psychology; D012111:Residence Characteristics; D015813:Substance Abuse Detection; D013997:Time Factors
D003932:Heroin