TY - JOUR
T1 - Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence
T2 - Post-intervention outcomes
AU - Defulio, Anthony
AU - Silverman, Kenneth
PY - 2011/5
Y1 - 2011/5
N2 - Aims Due to the chronicity of cocaine dependence, practical and effective maintenance interventions are needed to sustain long-term abstinence. We sought to assess the effects of long-term employment-based reinforcement of cocaine abstinence after discontinuation of the intervention. Design Participants who initiated sustained opiate and cocaine abstinence during a 6-month abstinence reinforcement and training program worked as data entry operators and were randomly assigned to a group that could work independently of drug use (control, n=24), or an abstinence-contingent employment (n=27) group that was required to provide cocaine- and opiate-negative urine samples to work and maintain maximum rate of pay. Setting A non-profit data entry business. Participants Unemployed welfare recipients who persistently used cocaine while in methadone treatment. Measurements Urine samples and self-reports were collected every 6 months for 30 months. Findings During the employment year, abstinence-contingent employment participants provided significantly more cocaine-negative samples than controls (82.7% and 54.2%; P=0.01, OR=4.61). During the follow-up year, the groups had similar rates of cocaine-negative samples (44.2% and 50.0%; P=0.93) and human immunodeficiency virus risk behaviors. Participants' social, employment, economic and legal conditions were similar in the two groups across all phases of the study. Conclusions Employment-based reinforcement effectively maintains long-term cocaine abstinence, but many patients relapse to use when the abstinence contingency is discontinued, even after a year of abstinence-contingent employment. Relapse could be prevented in many patients by leaving employment-based abstinence reinforcement in place indefinitely, which could be facilitated by integrating it into typical workplaces.
AB - Aims Due to the chronicity of cocaine dependence, practical and effective maintenance interventions are needed to sustain long-term abstinence. We sought to assess the effects of long-term employment-based reinforcement of cocaine abstinence after discontinuation of the intervention. Design Participants who initiated sustained opiate and cocaine abstinence during a 6-month abstinence reinforcement and training program worked as data entry operators and were randomly assigned to a group that could work independently of drug use (control, n=24), or an abstinence-contingent employment (n=27) group that was required to provide cocaine- and opiate-negative urine samples to work and maintain maximum rate of pay. Setting A non-profit data entry business. Participants Unemployed welfare recipients who persistently used cocaine while in methadone treatment. Measurements Urine samples and self-reports were collected every 6 months for 30 months. Findings During the employment year, abstinence-contingent employment participants provided significantly more cocaine-negative samples than controls (82.7% and 54.2%; P=0.01, OR=4.61). During the follow-up year, the groups had similar rates of cocaine-negative samples (44.2% and 50.0%; P=0.93) and human immunodeficiency virus risk behaviors. Participants' social, employment, economic and legal conditions were similar in the two groups across all phases of the study. Conclusions Employment-based reinforcement effectively maintains long-term cocaine abstinence, but many patients relapse to use when the abstinence contingency is discontinued, even after a year of abstinence-contingent employment. Relapse could be prevented in many patients by leaving employment-based abstinence reinforcement in place indefinitely, which could be facilitated by integrating it into typical workplaces.
KW - Abstinence reinforcement
KW - Cocaine
KW - Contingency management
KW - Employment
KW - Methadone
UR - http://www.scopus.com/inward/record.url?scp=79953791117&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79953791117&partnerID=8YFLogxK
U2 - 10.1111/j.1360-0443.2011.03364.x
DO - 10.1111/j.1360-0443.2011.03364.x
M3 - Article
C2 - 21226886
AN - SCOPUS:79953791117
SN - 0965-2140
VL - 106
SP - 960
EP - 967
JO - Addiction
JF - Addiction
IS - 5
ER -