Broad beneficial effects of cocaine abstinence reinforcement among methadone patients.

Silverman, Kenneth; Wong, Conrad J.; Umbricht-Schneiter, Annie; Montoya, Iván D.; Schuster, Charles R.; Preston, Kenzie L.

doi:10.1037/0022-006x.66.5.811

Cited by 170 publications

(172 citation statements)

References 44 publications

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“…Lastly, there was a relatively high attrition rate before randomization. However, it should be noted that the attrition rate in the present study is comparable with that of previous studies in methadone-maintained patients receiving CM (Preston, Umbricht, & Epstein, 2000;Preston et al, 2001;Silverman et al, 1998).In summary, our findings suggest that a computer-automated prize-based reinforcement procedure with sufficiently high density of reinforcement may effectively produce persistent reductions in the use of cocaine, as well as long-lasting decreases in cocaine-use-associated problems, in methadone-maintenance patients who continue to use while in treatment. The results of this study are likely to generalize to other cocaine or opiate treatment trials in different settings.…”

supporting

confidence: 87%

Randomized trial of prize-based reinforcement density for simultaneous abstinence from cocaine and heroin.

Ghitza¹,

Epstein²,

Schmittner³

et al. 2007

Journal of Consulting and Clinical Psychology

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To examine the effect of reinforcer density in prize-based abstinence reinforcement, heroin/cocaine users (N = 116) in methadone maintenance (100 mg/day) were randomly assigned to a noncontingent control group (NonC) or to 1 of 3 groups that earned prize draws for abstinence: manual drawing with standard prize density (MS) or computerized drawing with standard (CS) or high (CH) density. Probabilities (prizes/draw) were standard (50%) and high (78%); prize density was double blind. Mean prize values were CH, $286; CS, $167; MS, $139; and NonC, $171. Outcomes were % opioid/ cocaine-negative urines during the 12-week intervention and then 8 weeks postintervention as well as diagnosis of dependence up to 6 months poststudy. CH had significantly more negative specimens than did NonC during intervention and had more than all groups during postintervention treatment: Mean % negative (95% confidence interval) during postintervention treatment adjusted for baseline drug use and dropout were CH, 55% (14%-90%); CS, 7% (1%-27%); MS, 4% (1%-12%); and NonC, 3% (1%-10%). Current cocaine dependence diagnoses after treatment were significantly lower in contingent compared with noncontingent groups. Computerized drawing with higherdensity prizes enhanced reduction of cocaine use; abstinence reinforcement had long-term therapeutic benefits. Keywords contingency management; opiate; cocaine dependence; opiate dependence; methadone maintenance One of the most robust means of inducing behavioral change in patients with heroin and cocaine dependence is a set of behavioral techniques called contingency management (CM;Higgins et al., 1991;Higgins & Silverman, 1999). An especially powerful component of CM is a voucherbased escalating-reinforcement schedule developed by Higgins et al. (1991), in which reinforcement increases with each consecutive drug-negative urine sample. This procedure has repeatedly been shown effective in the treatment of cocaine abuse and dependence, with or without concurrent dependence on heroin (Higgins et al., 1991;Silverman et al., 1996). Compared with a control procedure in which equivalent values of vouchers are given independent of cocaine use, the escalating-reinforcement procedure reduces the frequency of cocaine use, increases the mean duration of abstinence, reduces patients' ratings of their desire for cocaine, and increases the frequency with which abstainers report engaging in coping behaviors .Correspondence concerning this article should be addressed to Udi E. Ghitza, Clinical Pharmacology and Therapeutics Branch, Treatment Section, IRP, NIDA, NIH, 5500 Nathan Shock Drive, Baltimore, MD 21224. E-mail: ghitzau@intra.nida.nih.gov. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThe voucher reinforcers used in the escalating-reinforcement procedure are certificates presented immediately on provision of a drug-negative urine sample; monetary values indicated on the certificates accrue and are redeemable later for a variety of goods and services. The use...

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supporting

confidence: 87%

Randomized trial of prize-based reinforcement density for simultaneous abstinence from cocaine and heroin.

Ghitza¹,

Epstein²,

Schmittner³

et al. 2007

Journal of Consulting and Clinical Psychology

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“…Current evidence suggests that substance users with ASPD respond particularly well to treatment programs that offer reinforcement contingencies (Brooner et al, 1998;Messina, Farabee, & Rawson, 2003;Silverman et al, 1998). For example, Messina and colleagues (2003) randomly assigned a group of methadone maintained cocaine users with and without ASPD to one of four treatment conditions including cognitive-behavioral therapy (CBT), contingency management (CM), cognitive-behavioral therapy plus contingency management (CBT + CM), or methadone maintenance (MM).…”

Section: Discussionmentioning

confidence: 99%

“…However, a voluntary-treatment comparison group was not included in the study. This omission is important because it precludes comparison with ASPD drug users receiving treatment on a voluntary basis, who may be at a heightened risk for treatment dropout in the absence of treatments with clear contingencies for remaining in treatment (Brooner, Kidorf, King, & Stoller, 1998;Messina, Farabee, & Rawson, 2003;Silverman et al, 1998). Thus, the current study attempts to further address this issue by examining the interactive effects of courtmandated treatment and ASPD status on treatment dropout among 236 inner-city male substance users receiving residential substance abuse treatment through a pretrial release to treatment program.…”

Section: Introductionmentioning

confidence: 99%

The interactive effects of antisocial personality disorder and court-mandated status on substance abuse treatment dropout

Daughters

Stipelman

Sargeant

et al. 2008

Journal of Substance Abuse Treatment

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The present study sought to examine the interactive effects of court-mandated (CM) treatment and antisocial personality disorder (ASPD) on treatment dropout among 236 inner-city male substance users receiving residential substance abuse treatment through a pretrial release to treatment program. Of the 236 participants, 39.4% (n = 93) met criteria for ASPD and 72.5 % (n = 171) were mandated to treatment by the court system. Results indicated a significant interaction between ASPD and CM status, such that ASPD patients voluntarily receiving treatment were significantly more likely to drop out of treatment than each of the other groups. Subsequent discrete-time survival analyses to predict days until dropout using Cox proportional hazards regression indicated similar findings, with ASPD patients voluntarily receiving treatment completing fewer days of treatment than each of the other groups. These findings suggest the effectiveness of the court system in retaining ASPD patients, as well as the role of ASPD in predicting treatment dropout for individuals who are voluntarily in treatment. Implications are discussed including the potential value of early implementation of specialized interventions aimed at improving adherence for ASPD patients who are receiving treatment voluntarily.

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“…Opiate and cocaine dependence are highly responsive to contingency management (CM), a behavioral therapy in which abstinence (usually as measured by drug-negative biological specimens) is reinforced by the delivery of a monetary voucher, an opportunity to draw for a prize, or some other desired item or privilege (Higgins et al, 1991;Silverman et al, 1996;Bigelow et al, 1998;Silverman et al, 1998;Piotrowski et al, 1999;Downey et al, 2000;Higgins et al, 2000;Kellogg et al, 2005). CM has been particularly useful in decreasing the use of cocaine in patients in methadone maintenance (Piotrowski et al, 1999;Silverman et al, 1998;Silverman et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…CM has been particularly useful in decreasing the use of cocaine in patients in methadone maintenance (Piotrowski et al, 1999;Silverman et al, 1998;Silverman et al, 2004). Although methadone maintenance is a very effective treatment for opioid dependence, continued use of non-opioid drugs during treatment is a significant problem for many patients (Bleich et al, 2002;Drake et al, 1993;Stitzer et al, 1992).…”

Section: Introductionmentioning

confidence: 99%

Self-report of illicit benzodiazepine use on the Addiction Severity Index predicts treatment outcome

Ghitza

Epstein

Preston

2008

Drug and Alcohol Dependence

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The relationship between pretreatment illicit benzodiazepine use (days of use in the last 30) assessed on the Addiction Severity Index (ASI) and treatment outcome was investigated by retrospective analysis of data from two controlled clinical trials in 361 methadone maintained cocaine/opiate users randomly assigned to 12-week voucher-or prize-based contingency management (CM) or control interventions. Based on screening ASI, participants were identified as nonusers (BZD-N; 0 days of use) or users (BZD-U; >0 days of use). Outcome measures were: urine drug screens (thrice weekly); quality of life and self-reported HIV-risk behaviors (every 2 weeks); and current DSM-IV diagnosis of cocaine and heroin dependence (study exit). In the CM group, BZD-U had significantly worse outcomes on in-treatment cocaine use, quality-of-life scores, needle-sharing behaviors, and current heroin dependence diagnoses at study exit compared to BZD-N. In the control group, BZD-U had significantly higher in-treatment cocaine use but did not differ from BZD-N on psychosocial measures. Thus, in a sample of non-dependent BZD users, self-reported illicit BZD use on the ASI, even at low levels, predicted worse outcome on cocaine use and blunted response to CM.

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Broad beneficial effects of cocaine abstinence reinforcement among methadone patients.

Cited by 170 publications

References 44 publications

Randomized trial of prize-based reinforcement density for simultaneous abstinence from cocaine and heroin.

Randomized trial of prize-based reinforcement density for simultaneous abstinence from cocaine and heroin.

The interactive effects of antisocial personality disorder and court-mandated status on substance abuse treatment dropout

Self-report of illicit benzodiazepine use on the Addiction Severity Index predicts treatment outcome

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