title: Employment-based reinforcement of adherence to oral naltrexone in unemployed injection drug users: 12-month outcomes.
abstract: Oral naltrexone could be a promising relapse-prevention pharmacotherapy for recently detoxified opioid-dependent patients; however, interventions are often needed to promote adherence with this treatment approach. We recently conducted a study to evaluate a 26-week employment-based reinforcement intervention of oral naltrexone in unemployed injection drug users (Dunn et al., 2013). Participants were randomly assigned into a contingency (n = 35) group required to ingest naltrexone under staff observation to gain entry into a therapeutic workplace or a prescription (n = 32) group given a take-home supply of oral naltrexone and access to the workplace without observed ingestion. Monthly urine samples were collected and analyzed for evidence for naltrexone adherence, opioid use, and cocaine use. As previously reported, contingency participants provided significantly more naltrexone-positive urine samples than prescription participants during the 26-week intervention period. The goal of this current study is to report the 12-month outcomes, which occurred 6 months after the intervention ended. Results at the 12-month visit showed no between-groups differences in naltrexone-positive, opioid-negative, or cocaine-negative urine samples and no participant self-reported using naltrexone at the follow-up visit. These results show that even after a period of successfully reinforced oral naltrexone adherence, longer-term naltrexone use is unlikely to be maintained after reinforcement contingencies are discontinued. (PsycINFO Database Record
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Kelly
authors.initials: K
authors.lastname: Dunn
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Anthony
authors.initials: A
authors.lastname: DeFulio
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Everly
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Wendy D
authors.initials: WD
authors.lastname: Donlin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Will M
authors.initials: WM
authors.lastname: Aklin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nuzzo
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Jeannie-Marie S
authors.initials: JM
authors.lastname: Leoutsakos
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Annie
authors.initials: A
authors.lastname: Umbricht
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Michael
authors.initials: M
authors.lastname: Fingerhood
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: George E
authors.initials: GE
authors.lastname: Bigelow
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Silverman
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D055030:Drug Users; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use* / Q000652:urine; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D012054:Reinforcement, Psychology; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome; D014478:Unemployment
chemical_list: D009271:Naltrexone