Promoting abstinence from cocaine and heroin with a methadone dose increase and a novel contingency

被引:47
作者
Epstein, David H. [1 ]
Schmittner, John [1 ]
Umbricht, Annie [1 ]
Schroeder, Jennifer R. [1 ]
Moolchan, Eric T. [1 ]
Preston, Kenzie L. [1 ]
机构
[1] Natl Inst Drug Abuse, Treatment Sect, Clin Pharmacol & Therapeut Branch, Intramural Res Branch, Baltimore, MD 21224 USA
关键词
Contingency management; Polydrug dependence; Methadone dose; DSM diagnoses; CLINICAL-TRIALS; MAINTENANCE TREATMENT; DRUG-ABUSE; OUTPATIENT TREATMENT; OPIOID DEPENDENCE; REINFORCEMENT; MANAGEMENT; BUPRENORPHINE; ADDICTION; RELIABILITY;
D O I
10.1016/j.drugalcdep.2008.11.006
中图分类号
R194 [卫生标准、卫生检查、医药管理];
学科分类号
摘要
To test whether a combination of contingency management and methadone dose increase would promote abstinence from heroin and cocaine, we conducted a randomized controlled trial using a 2 x 3 (dose x contingency) factorial design in which dose assignment was double-blind. Participants were 252 heroin- and cocaine-abusing outpatients on methadone maintenance. The were randomly assigned to methadone dose (70 or 100 mg/day, double-blind) and voucher condition (noncontingent, contingent on cocaine-negative urines, or "split"). The "split" contingency was a novel contingency that reinforced abstinence from either drug while doubly reinforcing simultaneous abstinence from both: the total value of incentives was "split" between drugs to contain costs. The main outcome measures were percentages of urine specimens negative for heroin. cocaine, and both simultaneously; these were monitored during a 5-week baseline of standard treatment (to determine Study eligibility), a 12-week intervention, and a 10-week maintenance phase (to examine intervention effects in return-to-baseline conditions). DSM-IV criteria for ongoing drug dependence were assessed at study exit. Urine-screen results showed that the methadone dose increase reduced heroin use but not cocaine use. The split 100 mg group was the only group to achieve a longer duration of simultaneous negatives than its same-dose noncontingent control group. The frequency of DSM-IV opiate and cocaine dependence diagnoses decreased in the active intervention groups. For a split contingency to promote simultaneous abstinence from cocaine and heroin, a relatively high dose of methadone appears necessary but not sufficient; an increase in overall incentive amount may also be required. Published by Elsevier Ireland Ltd.
引用
收藏
页码:92 / 100
页数:9
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