Increasing opiate abstinence through voucher-based reinforcement therapy

Kenneth Silverman, Conrad J. Wong, Stephen T. Higgins, Robert Brooner, Ivan D. Montoya, Carlo Contoreggi, Annie Umbricht-Schneiter, Charles R. Schuster, Kenzie L. Preston

Research output: Contribution to journalArticle

Abstract

Heroin dependence remains a serious and costly public health problem, even in patients receiving methadone maintenance treatment. This study used a within-subject reversal design to assess the effectiveness of voucher-based abstinence reinforcement in reducing opiate use in patients receiving methadone maintenance treatment in an inner-city program. Throughout the study subjects received standard methadone maintenance treatment involving methadone, counseling, and urine monitoring (three times per week). Thirteen patients who continued to use opiates regularly during a 5-week baseline period were exposed to a 12-week program in which they received a voucher for each opiate-free urine sample provided the vouchers had monetary values that increased as the number of consecutive opiate-free urines increased. Subjects continued receiving standard methadone maintenance for 8 weeks after discontinuation of the voucher program (return-to-baseline). Tukey's posthoc contrasts showed that the percentage of urine specimens that were positive for opiates decreased significantly when the voucher program was instituted (P ≤ 0.01) and then increased significantly when the voucher program was discontinued during the return-to-baseline condition (P ≤ 0.01). Rates of opiate positive urines in the return-to-baseline condition remained significantly below the rates observed in the initial baseline period (P ≤ 0.01). Overall, the study shows that voucher-based reinforcement contingencies can decrease opiate use in heroin dependent patients receiving methadone maintenance treatment.

Original languageEnglish (US)
Pages (from-to)157-165
Number of pages9
JournalDrug and Alcohol Dependence
Volume41
Issue number2
DOIs
StatePublished - Jun 1996

Fingerprint

Opiate Alkaloids
reinforcement
Methadone
Reinforcement
Urine
Heroin
Therapeutics
Heroin Dependence
contingency
counseling
public health
Public health
Medical problems
Reinforcement (Psychology)
monitoring
Counseling
Public Health

Keywords

  • Abstinence reinforcement
  • Contingency management
  • Drug abuse
  • Heroin abuse
  • Heroin dependence
  • Intravenous drug abuse
  • Treatment

ASJC Scopus subject areas

  • Medicine(all)
  • Behavioral Neuroscience
  • Toxicology
  • Health(social science)

Cite this

Increasing opiate abstinence through voucher-based reinforcement therapy. / Silverman, Kenneth; Wong, Conrad J.; Higgins, Stephen T.; Brooner, Robert; Montoya, Ivan D.; Contoreggi, Carlo; Umbricht-Schneiter, Annie; Schuster, Charles R.; Preston, Kenzie L.

In: Drug and Alcohol Dependence, Vol. 41, No. 2, 06.1996, p. 157-165.

Research output: Contribution to journalArticle

Silverman, K, Wong, CJ, Higgins, ST, Brooner, R, Montoya, ID, Contoreggi, C, Umbricht-Schneiter, A, Schuster, CR & Preston, KL 1996, 'Increasing opiate abstinence through voucher-based reinforcement therapy', Drug and Alcohol Dependence, vol. 41, no. 2, pp. 157-165. https://doi.org/10.1016/0376-8716(96)01246-X
Silverman, Kenneth ; Wong, Conrad J. ; Higgins, Stephen T. ; Brooner, Robert ; Montoya, Ivan D. ; Contoreggi, Carlo ; Umbricht-Schneiter, Annie ; Schuster, Charles R. ; Preston, Kenzie L. / Increasing opiate abstinence through voucher-based reinforcement therapy. In: Drug and Alcohol Dependence. 1996 ; Vol. 41, No. 2. pp. 157-165.
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