title: Can reinforcement-based interventions to reduce drug use successfully be adapted to routine opioid maintenance treatment?
abstract: BACKGROUND
  Comorbid substance related disorders are a major health problem for patients in opioid maintenance treatment (OMT). It was investigated whether a reinforcement scheme adapted to the regulatory and financial restrictions of routine treatment reduces concomitant drug use.
  
  
  METHODS
  OMT patients from 7 clinics who were using cocaine, benzodiazepines, heroin or amphetamines were randomly allocated to either treatment as usual (n = 64) or treatment with an additional escalating reinforcement scheme (n = 72) in which a patient's number of weekly take-home dosages was increased after 1, 4, 8 and 12 consecutive weeks with drug-free urine specimens. Trial duration was 26 weeks.
  
  
  RESULTS
  Completion rates were 64% for controls and 62.5% in the experimental group. Mean number of drug-free weeks was 11.3 (SD 8.5) for the control group and 9.8 (8.9) for the experimental group (p = 0.30).
  
  
  CONCLUSIONS
  The intervention was not effective compared to routine treatment. Additional features might be necessary to achieve an effect, e.g. a higher frequency of urine sampling or use of other reinforcers. It has to be further investigated how interventions which have been proven effective in experimental studies can successfully be adapted to routine care conditions.
authors: Arbeitsgruppe Klinische Suchtforschung an der Klinik für Psychiatrie und Psychotherapie, LVR-Klinikum Essen, Universität Duisburg-Essen, Essen, Germany.
authors: Michael
authors: M
authors: Specka
authors: Antje
authors: A
authors: Böning
authors: Jürgen
authors: J
authors: Kluwig
authors: Fabrizio
authors: F
authors: Schifano
authors: Markus
authors: M
authors: Banger
authors: Wolfgang
authors: W
authors: Lange
authors: Hildegard
authors: H
authors: Lax
authors: Bärbel
authors: B
authors: Marrziniak
authors: Claudia
authors: C
authors: Schüngel
authors: Norbert
authors: N
authors: Scherbaum
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D008297:Male; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010349:Patient Compliance; D012054:Reinforcement, Psychology