title: Contingency management and levodopa-carbidopa for cocaine treatment: a comparison of three behavioral targets.
abstract: New data support use of levodopa pharmacotherapy with behavioral contingency management (CM) as one efficacious combination in cocaine dependence disorder treatment. A potential mechanism of the combined treatment effects may be related to dopamine-induced enhancement of the saliency of contingently delivered reinforcers. Evidence to support this mechanism was sought by evaluating levodopa-enhancing effects across distinct CM conditions that varied in behavioral targets. A total of 136 treatment-seeking, cocaine dependent subjects participated in this 12-week, randomized, placebo-controlled trial of levodopa (vs. placebo) administered in combination with one of three behavioral CM conditions. In the CM-URINE condition, subjects received cash-valued vouchers contingent on cocaine-negative urine toxicology results. In the CM-ATTEND condition, the same voucher schedule was contingent on attending thrice weekly clinic visits. In the CM-MEDICATION condition, the same voucher schedule was contingent on Medication Event Monitoring Systems- and riboflavin-based evidence of pill-taking behavior. Primary outcomes associated with each CM target behavior were analyzed using generalized linear mixed models for repeated outcomes. CM responding in the CM-ATTEND and CM-MEDICATION conditions showed orderly effects, with each condition producing corresponding changes in targeted behaviors, regardless of medication condition. In contrast, CM responding in the CM-URINE condition was moderated by medication, with levodopa-treated subjects more likely to submit cocaine-negative urines. These findings specify the optimal target behavior for CM when used in combination with levodopa pharmacotherapy.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas-Houston, Houston, TX, USA. joy.m.schmitz@uth.tmc.edu
authors.forename: Joy M
authors.initials: JM
authors.lastname: Schmitz
authors.forename: Jan A
authors.initials: JA
authors.lastname: Lindsay
authors.forename: Angela L
authors.initials: AL
authors.lastname: Stotts
authors.forename: Charles E
authors.initials: CE
authors.lastname: Green
authors.forename: F Gerard
authors.initials: FG
authors.lastname: Moeller
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D002230:Carbidopa / Q000627:therapeutic use*; D003042:Cocaine / Q000652:urine; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000628:therapy* / Q000652:urine; D015259:Dopamine Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016016:Proportional Hazards Models; D012054:Reinforcement, Psychology; D016896:Treatment Outcome
chemical_list: D015259:Dopamine Agents; D007980:Levodopa; D003042:Cocaine; D002230:Carbidopa