Employment-based abstinence reinforcement following inpatient detoxification in HIV-positive opioid and/or cocaine-dependent patients

Kelly Dunn, Michael I Fingerhood, Conrad J. Wong, Dace S. Svikis, Paul Nuzzo, Kenneth Silverman

Research output: Contribution to journalArticle

Abstract

Employment-based reinforcement interventions have been used to promote abstinence from drugs among chronically unemployed injection drug users. The current study used an employment-based reinforcement intervention to promote opioid and cocaine abstinence among opioid and/or cocaine-dependent, HIV-positive participants who had recently completed a brief inpatient detoxification. Participants (n = 46) were randomly assigned to an abstinence and work group that was required to provide negative urine samples in order to enter the workplace and to earn incentives for work (n = 16), a work-only group that was permitted to enter the workplace and to earn incentives independent of drug use (n = 15), and a no-voucher control group that did not receive any incentives for working (n = 15) over a 26-week period. The primary outcome was urinalysis-confirmed opioid, cocaine, and combined opioid/cocaine abstinence. Participants were 78% male and 89% African American. Results showed no significant betweengroups differences in urinalysis-verified drug abstinence or HIV risk behaviors during the 6-month intervention. The work-only group had significantly greater workplace attendance, and worked more minutes per day when compared to the no-voucher group. Several features of the study design, including the lack of an induction period, setting the threshold for entering the workplace too high by requiring immediate abstinence from several drugs, and increasing the risk of relapse by providing a brief detoxification that was not supported by any continued pharmacological intervention, likely prevented the workplace from becoming established as a reinforcer that could be used to promote drug abstinence. However, increases in workplace attendance have important implications for adult training programs.

Original languageEnglish (US)
Pages (from-to)75-85
Number of pages11
JournalExperimental and Clinical Psychopharmacology
Volume22
Issue number1
DOIs
StatePublished - Feb 2014

Fingerprint

Cocaine
Workplace
Opioid Analgesics
Inpatients
HIV
Motivation
Urinalysis
Pharmaceutical Preparations
Risk-Taking
Drug Users
African Americans
Reinforcement (Psychology)
Urine
Pharmacology
Education
Recurrence
Control Groups
Injections

Keywords

  • Contingency management
  • HIV
  • Incentive
  • Injection drug use
  • Therapeutic workplace

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Psychiatry and Mental health

Cite this

@article{bacf11fa852b42bc85b3053d5840150a,
title = "Employment-based abstinence reinforcement following inpatient detoxification in HIV-positive opioid and/or cocaine-dependent patients",
abstract = "Employment-based reinforcement interventions have been used to promote abstinence from drugs among chronically unemployed injection drug users. The current study used an employment-based reinforcement intervention to promote opioid and cocaine abstinence among opioid and/or cocaine-dependent, HIV-positive participants who had recently completed a brief inpatient detoxification. Participants (n = 46) were randomly assigned to an abstinence and work group that was required to provide negative urine samples in order to enter the workplace and to earn incentives for work (n = 16), a work-only group that was permitted to enter the workplace and to earn incentives independent of drug use (n = 15), and a no-voucher control group that did not receive any incentives for working (n = 15) over a 26-week period. The primary outcome was urinalysis-confirmed opioid, cocaine, and combined opioid/cocaine abstinence. Participants were 78{\%} male and 89{\%} African American. Results showed no significant betweengroups differences in urinalysis-verified drug abstinence or HIV risk behaviors during the 6-month intervention. The work-only group had significantly greater workplace attendance, and worked more minutes per day when compared to the no-voucher group. Several features of the study design, including the lack of an induction period, setting the threshold for entering the workplace too high by requiring immediate abstinence from several drugs, and increasing the risk of relapse by providing a brief detoxification that was not supported by any continued pharmacological intervention, likely prevented the workplace from becoming established as a reinforcer that could be used to promote drug abstinence. However, increases in workplace attendance have important implications for adult training programs.",
keywords = "Contingency management, HIV, Incentive, Injection drug use, Therapeutic workplace",
author = "Kelly Dunn and Fingerhood, {Michael I} and Wong, {Conrad J.} and Svikis, {Dace S.} and Paul Nuzzo and Kenneth Silverman",
year = "2014",
month = "2",
doi = "10.1037/a0034863",
language = "English (US)",
volume = "22",
pages = "75--85",
journal = "Experimental and Clinical Psychopharmacology",
issn = "1064-1297",
publisher = "American Psychological Association Inc.",
number = "1",

}

TY - JOUR

T1 - Employment-based abstinence reinforcement following inpatient detoxification in HIV-positive opioid and/or cocaine-dependent patients

AU - Dunn, Kelly

AU - Fingerhood, Michael I

AU - Wong, Conrad J.

AU - Svikis, Dace S.

AU - Nuzzo, Paul

AU - Silverman, Kenneth

PY - 2014/2

Y1 - 2014/2

N2 - Employment-based reinforcement interventions have been used to promote abstinence from drugs among chronically unemployed injection drug users. The current study used an employment-based reinforcement intervention to promote opioid and cocaine abstinence among opioid and/or cocaine-dependent, HIV-positive participants who had recently completed a brief inpatient detoxification. Participants (n = 46) were randomly assigned to an abstinence and work group that was required to provide negative urine samples in order to enter the workplace and to earn incentives for work (n = 16), a work-only group that was permitted to enter the workplace and to earn incentives independent of drug use (n = 15), and a no-voucher control group that did not receive any incentives for working (n = 15) over a 26-week period. The primary outcome was urinalysis-confirmed opioid, cocaine, and combined opioid/cocaine abstinence. Participants were 78% male and 89% African American. Results showed no significant betweengroups differences in urinalysis-verified drug abstinence or HIV risk behaviors during the 6-month intervention. The work-only group had significantly greater workplace attendance, and worked more minutes per day when compared to the no-voucher group. Several features of the study design, including the lack of an induction period, setting the threshold for entering the workplace too high by requiring immediate abstinence from several drugs, and increasing the risk of relapse by providing a brief detoxification that was not supported by any continued pharmacological intervention, likely prevented the workplace from becoming established as a reinforcer that could be used to promote drug abstinence. However, increases in workplace attendance have important implications for adult training programs.

AB - Employment-based reinforcement interventions have been used to promote abstinence from drugs among chronically unemployed injection drug users. The current study used an employment-based reinforcement intervention to promote opioid and cocaine abstinence among opioid and/or cocaine-dependent, HIV-positive participants who had recently completed a brief inpatient detoxification. Participants (n = 46) were randomly assigned to an abstinence and work group that was required to provide negative urine samples in order to enter the workplace and to earn incentives for work (n = 16), a work-only group that was permitted to enter the workplace and to earn incentives independent of drug use (n = 15), and a no-voucher control group that did not receive any incentives for working (n = 15) over a 26-week period. The primary outcome was urinalysis-confirmed opioid, cocaine, and combined opioid/cocaine abstinence. Participants were 78% male and 89% African American. Results showed no significant betweengroups differences in urinalysis-verified drug abstinence or HIV risk behaviors during the 6-month intervention. The work-only group had significantly greater workplace attendance, and worked more minutes per day when compared to the no-voucher group. Several features of the study design, including the lack of an induction period, setting the threshold for entering the workplace too high by requiring immediate abstinence from several drugs, and increasing the risk of relapse by providing a brief detoxification that was not supported by any continued pharmacological intervention, likely prevented the workplace from becoming established as a reinforcer that could be used to promote drug abstinence. However, increases in workplace attendance have important implications for adult training programs.

KW - Contingency management

KW - HIV

KW - Incentive

KW - Injection drug use

KW - Therapeutic workplace

UR - http://www.scopus.com/inward/record.url?scp=84893481738&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893481738&partnerID=8YFLogxK

U2 - 10.1037/a0034863

DO - 10.1037/a0034863

M3 - Article

C2 - 24490712

AN - SCOPUS:84893481738

VL - 22

SP - 75

EP - 85

JO - Experimental and Clinical Psychopharmacology

JF - Experimental and Clinical Psychopharmacology

SN - 1064-1297

IS - 1

ER -