Effects of varying the monetary value of voucher-based incentives on abstinence achieved during and following treatment among cocaine-dependent outpatients
Effects of varying the monetary value of voucher-based incentives on abstinence achieved during and following treatment among cocaine-dependent outpatients
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DOI：
10.1111/j.1360-0443.2006.01664.x
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发表时间：
2007-02-01
期刊：
影响因子：
6
通讯作者：
Badger, Gary J.
中科院分区：
文献类型：
--
作者：
Higgins, Stephen T.;Heil, Sarah H.;Badger, Gary J.
目的本研究旨在探讨是否增加戒毒门诊治疗期间实现可卡因依赖的量是一种有效的方法，以增加长期的可卡因戒断。设计：两种条件、平行组、随机对照试验。试验在一所大学的研究诊所进行。共有100名可卡因依赖门诊患者参加了试验。干预参与者被随机分配接受基于社区强化方法（CRA）的治疗，加上以相对较高的货币价值（最大值= 1995美元/12周）为基础的代金券激励，或CRA与代金券设置在相对较低的货币价值（最大值= 499美元/12周）。在为期24周的门诊治疗的最初12周内，可卡因阴性尿分析结果决定了患者的收入。测量结果使用尿液毒理学测试、问卷和其他自我报告工具进行评估。结果：增加代金券价值增加持续时间的可卡因戒断实现在24周的治疗期间。在整个18个月的随访期内，每3个月评估一次的可卡因戒断率在高价值代金券条件下高于低价值代金券条件下。治疗期间达到的禁欲持续时间预测随访期间的禁欲，尽管这种关系随着时间的推移而减弱。结论：在治疗最初几周内增加戒断相关激励措施的价值似乎是增加治疗期间和长期可卡因戒断的有效方法，但治疗期间戒断与长期结果的正相关性随着时间的推移而消失。
Aims This study examined whether increasing the amount of abstinence achieved during outpatient treatment for cocaine dependence is an effective method for increasing longer-term cocaine abstinence. Design A two-condition, parallel groups, randomized controlled trial was conducted. Setting The trial was conducted in a university-based research clinic. Participants A total of 100 cocaine-dependent outpatients participated in the trial. Intervention Participants were assigned randomly to receive treatment based on the community reinforcement approach (CRA) plus voucher-based incentives set at a relatively high monetary value (maximal value = $1995/12 weeks) or CRA with vouchers set at a relatively low monetary value (maximal value = $499/12 weeks). Vouchers were earned contingent on cocaine-negative urinalysis results during the initial 12 weeks of the 24-week outpatient treatment. Measurements Outcomes were evaluated using urine-toxicology testing, questionnaires and other self-report instruments. Findings Increasing voucher value increased the duration of continuous cocaine abstinence achieved during the 24-week treatment period. Point-prevalence cocaine abstinence assessed every 3 months throughout an 18-month follow-up period was greater in the high- than low-value voucher conditions. The duration of abstinence achieved during treatment predicted abstinence during follow-up, although that relationship weakened overtime. Conclusions Increasing the value of abstinence-contingent incentives during the initial weeks of treatment appears to represent an effective method for increasing during-treatment and longer-term cocaine abstinence, but the positive association of during-treatment abstinence with longer-term outcome dissipates with time.