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.
Jones
Hendree E
HE
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
Wong
Conrad J
CJ
Tuten
Michelle
M
Stitzer
Maxine L
ML
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