A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals.
OBJECTIVE
Previous research has reported that both contingency management (CM) and cognitive-behavioral therapy (CBT) are efficacious interventions for the treatment of stimulant abusers. The present study sought to directly compare the effectiveness of (CM) and (CBT) alone and in combination in reducing stimulant use.


METHODS
Randomized clinical trial.


METHODS
Stimulant-dependent individuals (n = 171).


METHODS
CM, CBT or combined CM and CBT, 16-week treatment conditions. CM condition participants received vouchers for stimulant-free urine samples. CBT condition participants attended three 90-minute group sessions each week.


METHODS
Participants were interviewed at baseline and weeks 17, 26 and 52. Measures included psychiatric disorders and alcohol and drug use and concomitant social problems.


RESULTS
CM procedures produced better retention and lower rates of stimulant use during the study period. Self-reported stimulant use was reduced from baseline levels at all follow-up points for all groups and urinalysis data did not differ between groups at follow-up. While CM produced robust evidence of efficacy during treatment application, CBT produced comparable longer-term outcomes. There was no evidence of an additive effect when the two treatments were combined.


CONCLUSIONS
This study suggests that CM is an efficacious treatment for reducing stimulant use and is superior during treatment to a CBT approach. CM is useful in engaging substance abusers, retaining them in treatment and helping them achieve abstinence from stimulant use. CBT also reduces drug use from baseline levels and produces comparable outcomes on all measures at follow-up.
Rawson
Richard A
RA
UCLA Integrated Substance Abuse Programs, Los Angeles, CA 90025, USA. rrawson@mednet.ucla.edu
McCann
Michael J
MJ
Flammino
Frank
F
Shoptaw
Steven
S
Miotto
Karen
K
Reiber
Chris
C
Ling
Walter
W
D000328:Adult; D019969:Amphetamine-Related Disorders / Q000628:therapy*; D019970:Cocaine-Related Disorders / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003216:Conditioning, Operant; D005260:Female; D006801:Humans; D008297:Male; D008694:Methamphetamine; D016896:Treatment Outcome
D008694:Methamphetamine