EVALUATION OF NON-PHARMACOLOGICAL TREATMENTS OF SUBSTANCE ABUSE

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Two major projects were completed this year in which non-pharmacological treatments of substance abuse were tested. In the first project, a behavioral intervention, contingency management, was used to treat cocaine use among a group of methadone maintenance patients. In the second project the effects of intensity of counseling in cocaine dependence was evaluated. The effectiveness of contingency management procedures designed to produce sustained cocaine abstinence was evaluated in opioid-dependent cocaine abusers participating in a methadone maintenance program. Thirty-seven methadone maintenance subjects who used cocaine regularly during a 5-week baseline period were randomly assigned to either a contingency management group or to a yoked control group. Subjects in the contingency management group earned vouchers (exchangeable for goods or services) for providing cocaine-free urine samples (i.e., samples negative for benzoylecgonine); the value of the vouchers increased as the number of consecutive cocaine-free urine samples increased. Subjects in the yoked control group received vouchers of comparable value and at approximately the same frequency as subjects in the contingency management condition, but independent of the presence or absence of cocaine-free urines. Preliminary results indicate that the persons in the contingency management group achieved substantially longer periods of sustained abstinence from cocaine use than persons in the yoked control group. Counseling is an important element of virtually all drug abuse treatment; thus standardization and evaluation of counseling procedures is needed to establish effective treatment, whether counseling is the sole treatment or is given in combination with pharmacotherapy. A 12-week study was recently completed in which the efficacy of a standardized individual Cognitive/Behavioral/Interpersonal counseling program administered according to a specified therapy manual, given either twice weekly, once weekly, or every two weeks, were compared. Outcome measures included cocaine and other drug use (by self-report and urine toxicology), cocaine craving, psychological state, and psychosocial functioning. Preliminary analysis indicated that there were fewer initial drop-outs in the twice a week treatment group, but no significant differences in drug use outcome measures between groups after twelve weeks of treatment. The manual is currently being adapted for use in a group treatment format.