title: Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post-intervention outcomes.
abstract: OBJECTIVE
  Due to the chronicity of cocaine dependence, practical and effective maintenance interventions are needed to sustain long-term abstinence. We sought to assess the effects of long-term employment-based reinforcement of cocaine abstinence after discontinuation of the intervention.
  
  
  METHODS
  Participants who initiated sustained opiate and cocaine abstinence during a 6-month abstinence reinforcement and training program worked as data entry operators and were randomly assigned to a group that could work independently of drug use (control, n = 24), or an abstinence-contingent employment (n = 27) group that was required to provide cocaine- and opiate-negative urine samples to work and maintain maximum rate of pay.
  
  
  METHODS
  A non-profit data entry business.
  
  
  METHODS
  Unemployed welfare recipients who persistently used cocaine while in methadone treatment.
  
  
  METHODS
  Urine samples and self-reports were collected every 6 months for 30 months.
  
  
  RESULTS
  During the employment year, abstinence-contingent employment participants provided significantly more cocaine-negative samples than controls (82.7% and 54.2%; P = 0.01, OR = 4.61). During the follow-up year, the groups had similar rates of cocaine-negative samples (44.2% and 50.0%; P = 0.93) and human immunodeficiency virus risk behaviors. Participants' social, employment, economic and legal conditions were similar in the two groups across all phases of the study.
  
  
  CONCLUSIONS
  Employment-based reinforcement effectively maintains long-term cocaine abstinence, but many patients relapse to use when the abstinence contingency is discontinued, even after a year of abstinence-contingent employment. Relapse could be prevented in many patients by leaving employment-based abstinence reinforcement in place indefinitely, which could be facilitated by integrating it into typical workplaces.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA. adefuli1@jhmi.edu
authors.forename: Anthony
authors.initials: A
authors.lastname: DeFulio
authors.forename: Kenneth
authors.initials: K
authors.lastname: Silverman
mesh_terms: D000328:Adult; D015142:Baltimore; D001521:Behavior Therapy / Q000379:methods*; D001944:Breath Tests; D019970:Cocaine-Related Disorders / Q000534:rehabilitation* / Q000652:urine; D004651:Employment / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance; D012054:Reinforcement, Psychology; D012309:Risk-Taking; D012456:Salaries and Fringe Benefits; D055502:Secondary Prevention; D015813:Substance Abuse Detection
chemical_list: D009294:Narcotics; D008691:Methadone