title: A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users.
abstract: High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment. Participants could work 4 hr every weekday in a workplace where they could earn about $10.00 per hour in vouchers; they were required to provide routine urine samples. Participants who attended the workplace and provided cocaine-positive urine samples during the initial 4 weeks were invited to work 26 weeks and were randomly assigned to an abstinence-and-work (n = 28) or work-only (n = 28) group. Abstinence-and-work participants had to provide urine samples showing cocaine abstinence to work and maintain maximum pay. Work-only participants could work independent of their urinalysis results. Abstinence-and-work participants provided more (p = .004; OR = 5.80, 95% CI = 2.03-16.56) cocaine-negative urine samples (29%) than did work-only participants (10%). Employment-based abstinence reinforcement can increase cocaine abstinence.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 142 West, Baltimore, Maryland 21224, USA. ksilverm@jhmi.edu
authors.forename: Kenneth
authors.initials: K
authors.lastname: Silverman
authors.forename: Conrad J
authors.initials: CJ
authors.lastname: Wong
authors.forename: Mick
authors.initials: M
authors.lastname: Needham
authors.forename: Karly N
authors.initials: KN
authors.lastname: Diemer
authors.forename: Todd
authors.initials: T
authors.lastname: Knealing
authors.forename: Darlene
authors.initials: D
authors.lastname: Crone-Todd
authors.forename: Michael
authors.initials: M
authors.lastname: Fingerhood
authors.forename: Paul
authors.initials: P
authors.lastname: Nuzzo
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kolodner
mesh_terms: D003042:Cocaine / Q000652:urine; D019970:Cocaine-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D003710:Demography; D004651:Employment / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D015995:Prevalence; D012054:Reinforcement, Psychology; D012456:Salaries and Fringe Benefits / Q000191:economics / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D017132:Workplace / Q000706:statistics & numerical data
chemical_list: D009294:Narcotics; D003042:Cocaine; D008691:Methadone