Contingency management improves outcomes in cocaine-dependent outpatients with depressive symptoms.

Abstract

Despite depressive symptoms being very common among patients seeking treatment for cocaine dependence, few studies have examined the effects of depressive symptoms on cocaine outpatient treatment outcomes, and there is even less research in the context of Contingency Management (CM). The purpose of this study was to assess the main and interactive effects of co-occurring depressive symptoms on CM outcomes. Cocaine-dependent individuals (N = 108) were randomized to Community Reinforcement Approach (CRA) or CRA plus CM in two outpatient community clinical settings. Participants were categorized according to depression symptoms, self-reported by means of the BDI at treatment entry. Outcome measures included treatment retention and documented cocaine abstinence over a 6-month treatment period. Depressive symptoms were more commonly found in females and in unemployed participants, and were associated with more drug-related, social, and psychiatric problems at treatment entry. Individuals with baseline depressive symptoms had poorer treatment outcomes than patients without depressive symptoms. The addition of CM to CRA made the program more effective than with CRA alone, regardless of depressive symptoms. CM was associated with better abstinence treatment outcomes, while the interaction between unemployment and depressive symptoms was associated with negative retention treatment outcomes. This study supports the efficacy of CM for cocaine-dependent outpatients with and without depressive symptoms, and highlights its importance for improving treatment for unemployed and depressed cocaine-dependent individuals.

Substance Abuse Treatment Patients in Housing Programs Respond to Contingency Management Interventions

“…Participants randomly assigned to CM conditions, regardless of whether or not they resided in housing programs during the course of substance abuse treatment, stayed in treatment longer and achieved longer durations of abstinence than those randomized to standard care. These results are consistent with other studies suggesting that CM is efficacious across demographic (Barry, Sullivan, & Petry, 2009; Rash & Petry, 2015; Rash, Olmstead, & Petry, 2009; Rash, Andrade, & Petry, 2013; Wong, Badger, Sigmon, & Higgins, 2002), comorbid substance abuse (Alessi, Rash, & Petry, 2011; Garcia-Fernandez et al, 2011; Rash, Alessi, & Petry, 2008a), and other clinical characteristics (Garcia-Fernandez, Secades-Villa, Garcia- Rodriguez, Pena-Suarez, & Sanchez-Hervas, 2013; Petry, Rash, & Alessi, 2013; Petry, Rash, & Easton, 2011; Rash, Alessi, & Petry, 2008b). Our findings add to this literature by suggesting that individuals who use housing programs, many of which are alcohol- and drug-free, also respond to CM.…”

A review of the literature on contingency management in the treatment of substance use disorders, 2009–2014

“…Regarding illicit drug use disorders, studies were reported on CM reducing marijuana use (Kaminer et al, 2014; Stanger et al, 2009) among adolescents, and psychomotor stimulant and poly-drug use among those with co-morbid mental illness (García-Fernández et al, 2013; Kelly et al, 2014; McDonell et al, 2013; Petry et al, 2013), socioeconomic disadvantage (Secades-Villa et al, 2013), pregnant women and mothers of young children (Schottenfeld et al, 2011), sexual minorities (specifically men who have sex with men, Menza et al, 2010; Reback et al, 2010), those with HIV infection (Petry et al, 2010), and military veterans (Hagedorn et al, 2013). …”

Anhedonia Is Associated with Poorer Outcomes in Contingency Management for Cocaine Use Disorder

“…Anhedonia has high face validity as a moderator of CM treatment in particular, as lack of interest in non-drug rewards would naturally tend to work against the reward-based mechanism of CM; however, to our knowledge, this hypothesis has not previously been tested. Of note, studies examining the impact of depression on CM outcomes have produced mixed results (no association, worse outcomes, better outcomes), possibly due to the failure to distinguish anhedonia from negative mood symptoms of depression (Garcia-Fernandez, Secades-Villa, Garcia-Rodriguez, Pena-Suarez, & Sanchez-Hervas, 2013; Garcia-Fernandez et al, 2011; Gonzalez, Feingold, Oliveto, Gonsai, & Kosten, 2003; Milby et al, 2015). Thus, one objective of this study is to specifically test the relationship of anhedonia with CM outcomes.…”