METHADONE TREATMENT--BEHAVIORAL/PHARMACOLOGICAL VARIABLE

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Methadone treatment is the most widely available and effective treatment for opiate addiction. Because opiate users often abuse drugs other than opiates, methadone treatment should include interventions to reduce non- opioid drug use. A variety of factors in the treatment setting can be used to reinforce and modify behavior. Our previous research on contingency management procedures has used take-home doses of methadone and achieved modest success in reinforcing abstinence. In this continuation, we attempt to increase treatment success by using a token economy for flexible coordination of contingencies between multiple behaviors and multiple consequences. The enhanced contingency management intervention has the advantages of l) integrating multiple programmatic consequences, 2) reinforcing smaller units of behavior, 3) reinforcing multiple.appropriate behaviors, 4) introducing reinforcement from the first day of treatment, and 5) permitting more individualized treatment. A three group between subjects design with random assignment is used to compare the enhanced contingency management package (TOKEN group) to our previously assessed and successfully applied contingency management intervention (TAKE-HOME group) and to a no-reinforcement control condition (CONTROL group). These three groups represent a reinforcement dose response continuum. In all, 310 subjects (100 per group and 10 pilot subjects) will be recruited to participate in this nine-month protocol. TOKEN intervention subjects are expected to have superior treatment outcomes because we have integrated a number of behavioral components with demonstrated efficacy into a more comprehensive treatment package. Examination of the enhanced reinforcement program is also expected to provide insight into basic features of effective contingency management and drug abuse treatment. Multiple outcome measures will be used to determine relative treatment efficacy along a number of dimensions, as indicated by self-report and by objective indices, such as urine and breath analysis.