Incentives improve outcome in outpatient behavioral treatment of cocaine dependence.

OBJECTIVE: To assess whether incentives improved treatment outcome in ambulatory cocaine-dependent patients. METHOD: Forty cocaine-dependent adults were randomly assigned to behavioral treatment with or without an added incentive program. The behavioral treatment was based on the Community Reinforcement Approach and was provided to both groups. Subjects in the group with incentives received vouchers exchangeable for retail items contingent on submitting cocaine-free urine specimens during weeks 1 through 12 of treatment, while the group without incentives received no vouchers during that period. The two groups were treated the same during weeks 13 through 24. RESULTS: Seventy-five percent of patients in the group with vouchers completed 24 weeks of treatment vs 40% in the group without vouchers (P = .03). Average durations of continuous cocaine abstinence documented via urinalysis during weeks 1 through 24 of treatment were 11.7 +/- 2.0 weeks in the group with vouchers vs 6.0 +/- 1.5 weeks in the group without vouchers (P = .03). At 24 weeks after treatment entry, the voucher group evidenced significantly greater improvement than the no-voucher group on the Drug scale of the Addiction Severity Index (ASI), and only the voucher group showed significant improvement on the ASI Psychiatric scale. CONCLUSIONS: Incentives delivered contingent on submitting cocaine-free urine specimens significantly improve treatment outcome in ambulatory cocaine-dependent patients.

Alcohol dependence and simultaneous cocaine and alcohol use in cocaine-dependent patients.

Alcohol use and associated factors were studied in 124 consecutive cocaine-dependent admissions to an outpatient substance abuse clinic. Two analyses were conducted: First, those who did and did not meet criteria for current alcohol dependence were compared on sociodemographic and drug use characteristics. Second, patients who reported simultaneous cocaine and alcohol use on > 50% vs. < or = 50% of the occasions that they used cocaine were compared using the same dependent measures. Fifty-seven percent of patients met criteria for current alcohol dependence. Those with and without alcohol dependence did not differ on any sociodemographic characteristics, but those with dependence scored higher on the alcohol and family subscales of the Addiction Severity Index, the Michigan Alcoholism Screening Test, and measures of alcohol use, and were more likely to use cocaine and alcohol simultaneously, to use cocaine with friends and in social settings, and were more likely to report financial difficulties and unwanted sexual relations as adverse consequences of their cocaine use. Sixty-four percent of patients reported > 50% simultaneous cocaine and alcohol use. The two groups did not differ on any sociodemographic characteristics, but those reporting greater simultaneous use were more likely to be alcoholic, scored higher on most measures of alcohol use, and were more likely to report using cocaine with friends and in social settings. The only other differences observed between the two groups were fewer reports of seizures or difficulty concentrating in the group reporting greater simultaneous use. The present results confirm prior reports on the widespread prevalence of alcohol dependence among cocaine-dependent patients and extend them by providing new information on the prevalence and other characteristics of simultaneous cocaine and alcohol use.

The taking of free condoms in a drug abuse treatment clinic: the effects of location and posters.

Drug abuse treatment programs can help reduce high-risk sexual behavior in drug users by promoting condom use. This study examined the influence of distribution location and poster prompts on the taking of free condoms in a drug abuse treatment clinic. Over 6 months, condoms were available alternately, with and without poster prompts, in the clinic's private restroom or public waiting area. Overall, 381% more condoms were taken from the restroom. The presence of poster prompts did not affect condom taking. These results suggest that distribution location is a critical factor in promoting condom taking in public clinic.

Achieving cocaine abstinence with a behavioral approach.

OBJECTIVE: The authors compared the efficacy of a multicomponent behavioral treatment and drug abuse counseling for cocaine-dependent individuals. METHOD: The 38 patients were enrolled in outpatient treatment and were randomly assigned to the two treatments. Counseling in the behavioral treatment was based on the community reinforcement approach, while the drug abuse counseling was based on the disease model of dependence and recovery. Patients in the behavioral, but not the drug counseling, treatment also received incentives contingent on submitting cocaine-free urine specimens. RESULTS: Of the 19 patients who received behavioral treatment, 58% completed 24 weeks of treatment, versus 11% of the patients who received counseling. In the behavioral treatment group 68% and 42% of the patients achieved at least 8 and 16 weeks of documented continuous cocaine abstinence, respectively, versus 11% and 5% in the drug abuse counseling group. CONCLUSIONS: This multicomponent behavioral treatment appears to be an effective intervention for retaining outpatients in treatment and establishing cocaine abstinence.

A behavioral approach to achieving initial cocaine abstinence.

OBJECTIVE: The aim of this study was to assess the efficacy of a behavioral treatment program for achieving initial cocaine abstinence in individuals enrolled in outpatient treatment for cocaine dependence. METHOD: Thirteen consecutively admitted outpatients were offered behavioral treatment consisting of contingency management procedures and the community reinforcement approach. Fifteen consecutively admitted outpatients were offered treatment with 12-step counseling. All 13 of the patients who were offered the behavioral treatment accepted it; 12 of the patients offered 12-step counseling accepted it. RESULTS: Eleven of the 13 patients in the behavioral treatment were retained for 12 weeks of treatment, compared with five of the 12 patients given 12-step counseling. Ten of the patients given behavioral therapy achieved 4 weeks of continuous cocaine abstinence, compared with only three of those given 12-step counseling. Six of the patients in the behavioral treatment group achieved 8 weeks, and three achieved 12 weeks; none of the patients in the 12-step counseling program achieved 8 weeks. CONCLUSIONS: The behavioral treatment described in this paper offers promise as an effective intervention for achieving initial cocaine abstinence. A randomized trial is underway to assess the generality of these findings.