Contingency management and levodopa-carbidopa for cocaine treatment: a comparison of three behavioral targets.
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.
Schmitz
Joy M
JM
Department of Psychiatry and Behavioral Sciences, University of Texas-Houston, Houston, TX, USA. joy.m.schmitz@uth.tmc.edu
Lindsay
Jan A
JA
Stotts
Angela L
AL
Green
Charles E
CE
Moeller
F Gerard
FG
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
D015259:Dopamine Agents; D007980:Levodopa; D003042:Cocaine; D002230:Carbidopa