Maintenance of reinforcement to address the chronic nature of drug addiction.
BACKGROUND
Drug addiction can be a chronic problem. Abstinence reinforcement can initiate drug abstinence, but as with other treatments many patients relapse after the intervention ends. Abstinence reinforcement can be maintained to promote long-term drug abstinence, but practical means of implementing long-term abstinence reinforcement are needed.


METHODS
We reviewed 8 clinical trials conducted in Baltimore, MD from 1996 through 2010 that evaluated the therapeutic workplace as a vehicle for maintaining reinforcement for the treatment of drug addiction. The therapeutic workplace uses employment-based reinforcement in which employees must provide objective evidence of drug abstinence or medication adherence to work and earn wages.


RESULTS
Employment-based reinforcement can initiate (3 of 4 studies) and maintain (2 studies) cocaine abstinence in methadone patients, although relapse can occur even after long-term exposure to abstinence reinforcement (1 study). Employment-based reinforcement can also promote abstinence from alcohol in homeless alcohol dependent adults (1 study), and maintain adherence to extended-release naltrexone in opioid dependent adults (2 studies).


CONCLUSIONS
Treatments should seek to promote life-long effects in patients. Therapeutic reinforcement may need to be maintained indefinitely to prevent relapse. Workplaces could be effective vehicles for the maintenance of therapeutic reinforcement contingencies for drug abstinence and adherence to addiction medications.
Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 5200 Eastern Avenue, Baltimore, MD 21224, USA. ksilverm@jhmi.edu
Kenneth
K
Silverman
Anthony
A
DeFulio
Sigurdur O
SO
Sigurdsson
D000701:Analgesics, Opioid / Q000627:therapeutic use; D015142:Baltimore; D002986:Clinical Trials as Topic; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008691:Methadone / Q000627:therapeutic use; D009042:Motivation; D055502:Secondary Prevention; D015813:Substance Abuse Detection; D017132:Workplace
D000701:Analgesics, Opioid; D008691:Methadone